SOW Example - Exam Services DS261119.docx

EXAMINATION SERVICES (Contract #165CAP-M26-DS261119-01)

Statement of Work and Fees The Wisconsin Department of Safety and Professional Services (DSPS) (“Department”) and Pearson VUE (PV), a business of NCS Pearson, Inc., ("Contractor") and this Statement of Work (SOW) is governed by and incorporated into the Examination Delivery Service Agreement between the parties (“Agreement”). Capitalized terms not otherwise defined herein will have the same meanings as those assigned to them in the Contract and RFB #DS261119 documents.

1. INTRODUCTION/BACKGROUND

Contractor must provide Examination Services by professionally administering the Wisconsin Department of Safety and Professional Services (DSPS) licensing examinations for the Department.

2. SCOPE OF WORK

A. Development and Delivery of Examinations A computer-based examination system must be able to accept all Department examination content and forms for the real estate and trades professions.

The Department will send the Contractor all examination content and forms for the real estate and trades professions to be built into the computer-based examinations to be delivered by the Contractor.

B. Test Publication Contractor must publish the Department examination materials, which include examination forms, additional testing documents, including inserts or attachments to support examination items, and confidential information about the examinations and Candidates, in the Contractor's Delivery System.

C. Preliminary Review Prior to the Contractor submitting to the Department for examination approval, Contractor will perform a preliminary review of the following exam attributes according to the Department’s specifications:

· Test scores, if applicable

· Tests timed correctly

· Presentation of display screens and score reports

D. Item Bank and Published Forms The Department will provide the Contractor with a collection of over 350 Wisconsin specific examination law questions and answers, known as an Item Bank(s) to the Contractor.

i. The Contractor must update the Item Bank during the Contract period annually or based on requests from the Department.

ii. Contractor must administer the following Department trades examination supplements for 8.5” x 11” materials as digital exhibits in the computer-based examinations.

· Yellow Piping Sheet – Journeyman Plumber – Restricted Appliance

· MPRA Practical Graphics (Green Sheet) – Master Plumber – Restricted Appliance

· UDC – Plumbing Plans – UDC – Plumbing Inspector

· Weld Test Graphics – Weld Test Conductor

Other supplements may be presented in the computer-based examinations in the future upon mutual agreement by the Department and the Contractor.

iii. Contractor must publish four (4) forms for each of the following trades examinations:

· Journeyman Electrician

· Journeyman Plumber Part 1

· Journeyman Plumber Part 2

· Journeyman Plumber – Restricted Appliance

· Master Electrician

iv. Contractor must publish three (3) forms for all other trades examinations not listed in subsection ii. and iii. and included in this Agreement.

v. The Department must provide, in printed and laminated format, multiple copies (exact number to be determined) of supplemental materials for the Contractor to make available to Candidates at the Professional Centers for the examinations requiring them. Currently, these include the following:

· Hospital Plan

· Single Family Residence Plan

· Graphics Packet for Plumbing Examinations

· Other materials as agreed upon by both parties during the Contract term

E. Handbook Publication Contractor must design and produce a Candidate information handbook which must be reviewed and approved by the Department. The Candidate information handbook must be made available on the Contractor's website in an electronic format, and must, at a minimum, contain the following:

· Examination content outlines, as approved by the Department

· Process of applying for a license

· Registering for admission to an examination

· Rules regarding Candidate conduct during the examination

· Sample examination questions

· List/Link of approved reference materials for each examination type

· Appropriate forms and applications

· Special accommodation requests

F. Permitted Open Book Examination Materials

i. The specific open book materials permitted during examination administration must be agreed upon by Contractor and the Department prior to the trade program launch date.

ii. The number of materials and the materials to be included in a three-ring binder must be agreed upon by Contractor and the Department prior to the trade program launch date.

iii. The specific Professional Centers at which open book materials may be permitted must be agreed upon by the Department and the Contractor prior to the trade program launch date.

G. Professional Centers (PCs) Contractor PC’s and other agreed upon third-party locations must be identifiable and located in areas which provide adequate parking, lighting, ventilation, and an examination environment in compliance with the standards listed in the latest version of the Standards for Educational and Psychological Testing prepared by the Committee to Develop Standards for Educational and Psychological Testing of the American Educational Research Association (AERA), the American Psychological Association (APA), and the National Council on Measurement in Education (NCME).

i. Contractor PC’s and third-party locations must meet the requirements of the Americans with Disabilities Act (ADA) as well as approved special accommodations for Candidates.

ii. Contractor must provide trained staff throughout Wisconsin at Pearson VUE Professional Center’s (PPCs) and Pearson VUE Training Center’s (PVTCs) to accommodate the volume of Candidates requesting to take the examinations.

iii. Contractor must be able to accommodate and expand Professional Center (PC) availability, if applicable. The Department must approve PC’s and locations prior to examination administration.

iv. Contractor PPC Locations:

· Ashwaubenon

· Brookfield

· Eau Claire

· Kenosha

· Madison

· Milwaukee

v. Contractor must make available at least forty (40) third-party locations in Wisconsin, along with PVTC locations located along the boarding states (i.e. Illinois, Iowa, Michigan, and Minnesota) for examination administration. Current locations are listed under Exhibit B.

vi. All examinations permitting the use of supplemental materials provided by the Department to the appropriate testing center as listed here must be restricted to the PPC locations listed above.

vii. Contractor must hire, train, and pay proctors, examination supervisors, and technical support staff.

viii. Contractor must provide the Professional Center administration reference manual for Professional Center staff.

ix. Contractor must provide training for all Professional Center staff handling Candidate intake, examination, and after examination for Candidates.

H. Computer-Based Training (CBT) Station

i. Contractor must provide and maintain all necessary computer equipment, which is subject to the Department approval.

ii. Contractor must provide a workspace at each computer-based training (CBT) station.

iii. Contractor must have a separated workspace/CBT stations available to prevent observation by other Candidates as defined by the guidelines stated in the latest version of the latest version of the Standards for Educational and Psychological Testing prepared by the Committee to Develop Standards for Educational and Psychological Testing of the American Educational Research Association (AERA), the American Psychological Association (APA), and the National Council on Measurement in Education (NCME).

iv. Contractor must conduct a pre-examination orientation for each Candidate on the use of the computer station at the time of the examination.

v. Contractor must be responsible for examination and verification of software and other system features prior to use with Candidates to assure accurate delivery of the examination and accurate scoring.

I. Storage and Maintenance of Data

i. Contractor must store and maintain Item Bank(s) and records, such as examinations taken and examination results for the duration of this Contract, plus seven (7) years after the Contract.

ii. Contractor must not sell, share, or distribute a Candidate’s personal information to a third-party, such as a school, unless the third-party Contractor has been approved by the Department during the term of the Contract. Contractor will be permitted to distribute Candidate’s personal information to those third-party Contractors approved by the Department during the term of the Contract.

J. Website and Phone Number

i. Contractor's website must be available twenty-four (24) hours a day, seven (7) days a week, except during scheduled maintenance and at other times as notified on the website.

ii. Contractor must assign a dedicated toll-free phone number to the Contractor’s customer service center

iii. Contractor toll-free telephone reservation system must be available to Candidates through a United States based call center to schedule examinations. Contractor must provide confirmation numbers for all Candidates through the Contractor's toll-free telephone reservation system from 8:00 AM to 5:00 PM Central Time (CT) each Business Day.

iv. Contractor must be able to receive scheduling requests by Candidates via toll-free telephone number and Internet (Contractor’s website).

K. Program Management Contractor must assign a dedicated program manager to assist the Department in the implementation activities and serve as the primary point of contact for any on-going support issues. The program manager must:

i. Coordinate the implementation kick-off meeting between the Department and Contractor to review the implementation plan and to prioritize Test publication.

ii. Conduct regularly scheduled conference calls between the Department and Contractor to review the implementation progress (during the implementation period) and to facilitate communication regarding new examinations, revised examinations, and examination policy and program changes.

iii. Conduct in-person or virtual annual business reviews between the Contractor and the Department to address the Department’s satisfaction and sufficiency of service issues and facilitate discussions regarding upcoming program plans and other relevant business activities.

iv. Review with the Department result file formats and discuss any report format problems.

L. Accommodation Contactor must comply with the Americans with Disabilities Act (ADA) and other applicable federal and state laws by implementing the following:

i. Contractor must have a standard process and request forms for Candidate(s) to notify the Contractor electronically or in writing of a Candidate’s disability related request for examination accommodation(s).

ii. Contractor must review accommodation requests and make appropriate determinations for the Department. In those instances where an accommodation type has not been implemented, Contractor must consult with the Department as to the feasibility, timeline, and cost for such requests.

iii. Candidate must be directed at the steps, both on the Contractor website and published in the handbook, on how to schedule an examination appointment requiring accommodation.

iv. In the event a Candidate appeals for an accommodation decision, the Department must review such appeals and provide a final determination to the Contractor.

M. Candidate Security

i. Contractor staff must verify Candidate admittance authorization by validating the identity of the Candidate with the examination roster by using a government issued photo, such as a driver’s license.

ii. Contractor staff must review approved reference materials Candidate is bringing into the testing center for the applicable examination.

iii. Contractor staff must monitor Candidates during the examination to respond to questions and discourage cheating.

iv. Contractor must maintain examination security before, during, and after the examination at both the computer examination station and the test center levels. Contractor is liable for damages and other consequences resulting from the loss of examination material(s) under the Contractor's control and from any other security breach by the Contractor. Contractor agrees to use the examination Item Bank(s) only as intended by the Contract and to protect them from unauthorized disclosure.

v. Contractor staff must control Candidates trips to restrooms and outside of the Professional Center.

vi. Contractor staff must control access to papers and references as required by the examinations and collect any permitted materials at the conclusion of the examination.

vii. Contractor must be responsible for resolution of disputes regarding accuracy of computer stations, systems, programs, and records.

viii. Contractor staff must report any irregularities immediately to the Department. Examination irregularities include technical issues with the examinations, problems occurring with the physical location (i.e. a power outage), Candidates violating administration policies or cheating, and additional allegations by a testing Candidate of improper administration.

ix. Contractor must have an irregularity report form or documentation procedure to be sent to the Department via email.

x. Contractor must finalize investigations of any breaches of security of examination content within one (1) month of the event.

xi. Contractor’s Professional Center staff may deny entry or revoke access to the Candidate’s examination if a Candidate fails to follow the Contractor's examination rules and procedures.

xii. If an incident arises with a Candidate, the Contractor must take reasonable steps to resolve such Candidate issue(s). If the Contractor determines the Candidate's issue(s) is not the responsibility of Contractor, the Contractor must contact the Department for directions on how to proceed with the Candidate's examination. The Contractor and the Department agree to work diligently together to mutually resolve any such issue(s) with a Candidate.

N. Candidate Eligibility Except for Appraisers, who are screened by the Department, Candidates indicate eligibility for examination by checking the appropriate box on the application and signing an affidavit attesting to the accuracy of their application.

i. Contractor must be responsible for assuring the Candidate has been determined eligible by the Department before scheduling the examination.

ii. Contractor must verify the eligibility box is checked and the affidavit is signed.

iii. Candidates for Licensure must first apply with the Department. Upon determination of approval, the Department will send the list of approved Candidates to the Contractor. These Candidates must get the Department approval prior to registering for the examination with the Contractor. Contractor must verify the Candidate is eligible according to the list.

O. Registration and Scheduling of Candidates

i. Contractor must have written procedures for scheduling and notifying Candidates, which includes a policy for guaranteeing an appointment within a given number of days of the requested date, along with policies for cancellations and no-shows. All notices and Candidate information must be approved by the Department prior to use.

ii. Contractor must be able to schedule and provide daily or weekly access to Professional Centers based on the number of Candidates requesting examinations.

iii. Contractor must have examination schedules which include weekdays and Saturdays.

iv. Candidates must be permitted to make scheduling changes or cancellations to examination reservations at least forty-eight (48) hours prior to the examination at no additional fee.

v. Contractor must send a confirmation letter and payment receipt to Candidates via email.

vi. Contractor must be able to collect fees for examination via the toll-free telephone number and Internet (website).

vii. Contractor must collect all examination fees as outlined in Exhibit A from Candidates during the examination registration process. Contractor fees must be accepted in the form of a credit or debit card or other payments agreed upon by the Department and the Contractor.

All collected fees from the Candidate, examination and administrative fees will be retained by the Contractor and Department Fees must be returned to the Department as described under Section DD. Billing Summary.

P. Candidate Scoring/Notification of Examination Results

i. Contractor must score the broker and salesperson real estate examinations and set the passing score at the point which represents satisfactory minimum competence for licensure. Any recommended passing score must be legally defensible.

ii. Appraiser examinations passing scores are determined by the Appraisal Qualification Board (AQB) and are not determined by the Contractor nor the Department.

iii. Contractor must provide Candidates with their examination results, including a pass/fail indication, total score, and score by part, immediately after the examination.

iv. Examination results and demographic Data for passing Candidates, failing Candidates, and no-shows must be in an electronic format sent by the Contractor to the Department.

v. Contractor must develop a score report which includes diagnostic scores for all Candidates and instructions for obtaining a license or applying for re-examination.

vi. Score reports must contain an approved mechanism or code by which the Department can verify authenticity of score report without Contractor’s interruption.

Q. Candidate Comments and Optional Candidate Survey

i. Contractor must collect and review Candidate comments to determine if modifications to answer key or omission of questions from scoring are warranted. DSPS must be made aware of any comments leading to a change in content and be involved with the final decision-making process.

ii. Contractor must provide a form on which the Candidates may critique examination questions or procedures to be administered at the examination site after the Candidate has turned in answer sheets, but before the Candidate has exited the test center.

iii. Contractor must collect and review comments and make modifications only with DSPS written approval.

iv. Contractor must respond to Candidate inquiries within twenty-four (24) hours via the preferred method of the Candidate, i.e. phone, text, email, or any other messaging system the Contractor has developed to communicate with Candidates.

v. Contractor must conclude examinations with an optional Candidate survey, as the Department specifies, recording Candidate's opinion of the examination process. This information must be included in the Candidate’s Data file.

R. Electronic Score and Data Transfer Contractor must be responsible for the following:

i. Provide the Department with online access to the Candidate's scores on the day following the examination date.

ii. Score transfers between the Contractor and the Department must be performed by electronic Data transfers.

iii. Contractor must work with the Department to maintain system compatibility.

iv. Contractor must inform the Department of any changes to the electronic score transfers system at least one (1) month prior to any changes occurring.

v. Contractor must maintain a permanent file of all Candidates who submitted an application for an examination until the Candidate has successfully passed all examination requirements.

vi. Contractor must maintain for one (1) year, a permanent file of all Candidates who have taken the examinations, the examination question records, examination scores, and response record of each Candidate.

vii. Contractor must monitor dates of examinations and number of retakes allowed.

viii. Upon request, the Contractor must provide to the Department a statistical summary.

ix. Scores and Candidate information collected by the Contractor remain the property of the Department and must not be used without written permission of the Department for any purpose other than reporting to Candidates and preparing DSPS requested reports.

x. Contractor must acquire Candidate information and supply the Department, on a quarterly basis, with the examination performance statistics of Candidates by age, gender, and overall examination performance by content breakdown.

S. Candidate Authorization File Transfer Process

i. Contractor must acknowledge the Department has sole authority to determine the eligibility of the examination Candidates.

ii. Contractor must provide formatting rubric for the Department to send notification of Candidate eligibility to the Contractor through a specifically formatted pair of files (a Candidate demographic Data file and a Candidate examination authorization file) as described in a Candidate Data Interchange (or CDI) document.

iii. The Department will send notification of candidate eligibility to Contractor through a specifically formatted pair of files (a candidate demographic file and a candidate test authorization file) using a formatting rubric provided by the Contractor described in a Candidate Data Interchange (or CDI) document. See Section T. Candidate Data Interchange.

iv. Contractor’s first Data file must include Candidate demographic Data, which must include a unique identification (ID), Candidate name, address, phone number, email address, etc.

v. Contractor’s second Data file must include authorization information for the specific examination or examinations the Candidate is authorized to take.

vi. Contractor’s file must include the specific timeframe under which the Candidate is eligible to take the examination. Files must be sent from the Department as frequently as determined by the Department and the Contractor and must be accepted by the Contractor's eligibility processing system at least one (1) time per day.

vii. Contractor must accept the Department’s electronic files submitted to the Contractor in a flat file format through a secure file transfer process mutually agreed upon by the Department and the Contractor.

viii. Contractor must agree to accept the Department’s transfer of all necessary and required consent from the Candidate to transfer the Candidate's information to the Contractor for the Contractor's use as permitted or requested by the Department.

ix. Contractor must work with the Department when the Department resolves issues with any problematic eligibility files.

T. Candidate Data Interchange Contractor agrees there are two types of files required to be exchanged between the Contractor and the Department. These are required to be followed by the Contractor and the Department.

Data files as stated under Section U. Data Export must contain the data exported from the Department to the Contractor, or from the Contractor to the Department (such as Candidate Demographic Data).

Confirmation type files under Section V. Data Files must ensure the import/export loop is closed between the Contractor and the Department. These files are essential for detecting abandoned Candidate records to ensure Candidate examination results are processed in a timely fashion.

U. Data Export

i. DSPS must send the following types of Data to the Contractor and the Contractor must be able to accept these files:

· Candidate demographic Data

· Examination authorization Data authorizing specific Candidate’s to take specific examinations

· Confirmation files to verify import of Data from the Contractor

ii. Contractor must send the following types of Data to the Department:

· Candidate demographic Data

· Examination result Data Confirmation files to verify import of Data from the Department

iii. Contractor and the Department must be able to accept additional Data files sent to or from the Contractor which are by request only.

V. Data Files

i. Contractor must have established a standard set of files for sending and verifying Data. These files must meet industry standards and be imported into any database (DB), particularly modern relational databases. Each file type must have a standard set of Data fields which may be customized to meet the needs of the Department.

ii. File names may be configured for the Department by the Contractor. However, each file type must be named with a unique prefix, and all the files must have the same extension. The Department recommends all file names include a date and a sequence number to be guaranteed to be unique and be easily identifiable by date. For example, a CDD file sent to the Contractor may be “CDD-YYYY-MM-DD-nn.dat”.

iii. Contractor must provide industry-standard file format with tab-delimited.

The first line will be the header with a tab-delimited list of the names of the Data fields in the file. The Contractor will recommend the Data field names outlined be used; if the Department requests customized Data field names, the Contractor may recommend spaces not be used within any Data field names.

Each subsequent line contains the actual Data records and fields within a record are separated by a tab character. Each line will be terminated with a CR-LF sequence (carriage return).

If a record contains any special characters (tabs or quotes), those fields must be contained in double quotes. (Data not containing special characters must be omitted without quoting). For example, “ACME” must be sent as ““ACME”” and “AC ME” must be sent as “AC ME”. Characters such as carriage return, and line feed must not occur in these fields.

The Department recommends UTF-8 without a byte order mark for Data exchange. In addition, only characters within the CP1252 charset must be utilized. If the Contractor is interested in using other charsets, the Department must approve first.

W. Data File Transport

i. Data files sent from the Contractor must be packaged in a .zip archive.

ii. Data files sent from the Department to the Contractor must be accepted for import and must not be in a .zip archive to ensure proper return of the confirmation records.

iii. Data files must be sent to the Candidate on a scheduled basis, specified by the number of minutes from the last scheduled transmission. the Department can specify the initial send time and subsequent send interval. If there is no Data to transmit from the previous send, an empty file with only header information must be sent.

iv. Contractor must not combine examination results from Internet Based Testing (IBT) deliveries (such as Athena- Browser Edition) with the same Data feeds as Athena-Desktop deliveries. While the available Data is similar, technical constraints prevent combinations of different Data types results in one feed. Feeds can be configured to appear in similar formats to prevent Data processing issues.

In addition, the presence or absence of Data within individual fields will vary depending on the IBT driver used for examination delivery. If Data for “no shows” is desired for IBT examination registrations, those records will not appear in the same feed as results for examination deliveries. The format for the separate feed can remain the same.

v. For security and reliability, files are exchanged via automatic processes on an SFTP (Secure File Transfer Protocol) site. Either the Department SFTP site or the Contractor’s SFTP site must be used.

If the Contractor’s SFTP site is to be used, the Contractor’s Program Manager must assist with setup and access. If an alternative is required, the Contractor must work with the Department to obtain a secure transmission method.

vi. Contractor must be responsible for the defense of any actions and any resulting liability arising solely from breach or failure of the Contractor to perform their obligations under this Contract.

X. Examination Result Data File Transfer Process Contractor must provide the Department with each Candidate's examination Data file, including examination results and other examination-related files daily. The Contractor must send the Department Candidate examination Data via a mutually agreed upon secure internet connection to the Department designated server or service.

Y. Item Banks Contractor must work with the Department to develop examinations for the purpose of the Item Bank creation and reviews.

i. Contractor must provide a schedule of new Item Bank(s) to review with the Department yearly which will result in sufficient Item Bank(s) to prevent overexposure and loss of security of the individual Item Bank(s) for all examinations under this RFB. Additional Item Bank development must be required in response to State law and rule changes. There will be no overlap between real estate brokers and real estate salesperson Item Banks.

ii. Contractor must have the ability to perform Item Bank review conferences with the Department via electronic method for the purpose of performing quick reviews and decisions on examination content.

iii. Contractor must load and store Item Bank in a secure environment and perform updates to Item Bank as needed.

iv. Contractor must have procedures for validation review of all Item Bank for each examination by experts and committees per the resources provided by the Department.

v. Contractor must have written procedures for determining a criterion-referenced passing point recommendation for all examinations covered under this Contract.

vi. Contractor must include a small number of pretest Item Bank questions and answers, five to ten (5-10), to be administered to Candidates during examinations. Time taken to answer the Item Bank questions must not count against examination time.

vii. Contractor must have procedures for assuring all forms of the same examinations are comparable in difficulty.

viii. Contractor must attend an informational meeting in Wisconsin at the Department to describe the program to the Department staff upon request.

ix. Contractor must engage in meetings for examination development activities as required by the Department.

x. Contractor must use Item Bank analysis statistics and Candidate comments to evaluate the adequacy of all examination questions.

xi. Contractor must develop the procedures for handling questionable Item Bank and rescoring if necessary. The Contractor must provide procedures to the Department prior to implementation for written approval.

xii. Contractor must provide examination security. Internal controls must be used to ensure the security of the Item Bank during the initial examination development activities, as well as while in electronic storage and transit.

xiii. Contractor will be responsible for determining questions of examination fairness and compliance with applicable federal laws, rules, and regulations.

xiv. Contractor must provide, upon written request, a technical manual which documents examination development and validation activities, Item Bank examination, scoring, readability analysis, Item Bank examination and examination statistics, and any other requirements by the latest version of the Standards for Educational and Psychological Testing (American Educational Research Association).

xv. Contractor must permit the Department, upon the Department request, and under secure conditions, to review the form and content of representative examinations in active use.

xvi. The Department and the Contractor must conduct a review yearly of the State content specifications of the examinations depending on changes in State law and other State requirements.

Z. Ownership of Item Bank(s) Any Item Bank(s) developed by the Contractor under this Contract relating to Wisconsin regulations and rules or developed solely for any examination will be under the copyright of the Department.

i. Contractor must have no right, title, or interest in these Item Bank examination and the Item Bank must be provided to the Department upon termination of the Contract. The Contractor must not retain copies of the Item Banks.

ii. Any Item Bank provided by the Department to Contractor for use by the Contractor during the term of this Contract remain the property of the Department and must be returned to the Department upon termination of the Contract. The Contractor must not retain copies.

iii. The Department recognizes the Contractor may have copyright and other interests in materials other than the Item Bank prepared under this Contract. However, Contractor must grant the Department the right to use, copy, and distribute all or part of any such Item Bank(s) prepared for Candidates under this Contract.

All general Item Banks provided by the Contractor for use in the Wisconsin examinations which were developed for general use in the Contractor's other examinations will be under copyright of the Contractor.

AA. Services Performed within the U.S.

Pursuant to s. 16.705(1r), Wis. Stats., services must be performed within the United States. The inability to perform all services in the United States may be grounds for Contract cancellation.

AB. Fee Schedule The fee schedule must apply for the initial term of the Contract and must not be increased by the Contractor. Contractor must remit the fees to the Department as set forth in Exhibit A. All statutory payments to the general fund for real estate and appraiser examinations are included in the “Collected Fee back to DSPS” and will be distributed by the Department.

AC. Examination Reviews Contractor must offer a one (1) hour examination review appointment to Candidates who did not successfully pass their examination. Examination review appointments must be made via the Contractor’s website and proctored at a Professional Center.

Examination reviews must be charged an examination fee of $15.00 and a Contractor’s administrative fee of $34.00. All fees collected will be retained by the Contractor.

AD. Billing Summary Contractor must provide a billing summary, designed by the Department, of registered Candidates, reconciling each month's registration and financial activities, total fees collected, the amount submitted to the Department, and remit the reconciled amount to the Department by the 15th of the following month.

State of Wisconsin Contractor

Signature: Signature:

Agency Name: Company Name:

Name: _ Name:

Title:

Title:

Date: _ Date:

Exhibit A Fee Schedule

Exhibit B Locations

Adams, WI

X

Antigo, WI

X

Ashland, WI

X

Cleveland, WI (2)

X

Eau Claire, WI

X

Elkhorn, WI

X

Fennimore, WI

X

Fond Du Lac, WI

X

Fort Atkinson, WI

X

Green Bay, WI

X

Janesville, WI

X

Kenosha, WI

X

La Crosse, WI (2)

X

Madison, WI (3)

X

Marinette, WI

X

Marshfield, WI

X

Medford, WI

X

Mequon, WI

X

Milwaukee, WI (4)

X

New Richmond, WI

X

Oshkosh, WI

X

Pewaukee, WI (2)

X

Phillips, WI

X

Portage, WI

X

Racine, WI

X

Reedsburg, WI

X

Rhinelander, WI

X

Rice Lake, WI

X

Spencer, WI

X

Stevens Point, WI (2)

X

Sturgeon Bay, WI

X

Superior, WI

X

Tomah, WI

X

Watertown, WI

X

Wausau, WI

X

West Bend, WI

X

Whitewater, WI

X

Wisconsin Rapids, WI

X

Wittenberg, WI

X

Stanley, WI

X