SIGNED FINAL 5-22-23 _Women, Infants and Children (WIC) #154720

GRANT AGREEMENT MODIFICATION
between the
STATE OF WISCONSIN DEPARTMENT OF HEALTH SERVICES
And
SAUK CO PHD
for
2023 DPH Consolidated Contract

DPH Contract No.: 57890-2 Agreement Amount: $3,888
Agreement Term Period: 10/1/2022 to 9/30/2024
CARS Pre-Packet No: 23342
DHS Division: Division of Public Health DHS Grant Administrator: Anna Benton
DHS Email: DHSGACMail@dhs.wisconsin.gov
Grantee Grant Administrator: Ms Treemanisha Stewart Grantee Address: 505 BROADWAY STREET, BARABOO, 
WI, 53913
Grantee Email: treemanisha.stewart@saukcountywi.gov

Modification Description: We are adding funding for the Women, Infants and Children (WIC) Program 
(Profile 154720). Please see attached Scope(s) of Work. Final reports are due 45 days from the end 
of the designated contract period for any included profiles.
This is a Modification of an existing Agreement, as specified above. This Modification of Agreement 
encompasses both Amendments and Addendums to an existing Grant Agreement. This Modification is 
entered into by and between the State of Wisconsin Department of Health Services (DHS) and the 
Grantee listed above. With the exception of the terms being modified by this Grant Agreement 
Modification, ALL OTHER TERMS AND CONDITIONS OF THE EXISTING AGREEMENT, INCLUDING FUNDING, REMAIN 
IN FULL FORCE AND EFFECT. This Modification, including any and all attachments herein and the 
existing agreement, collectively, are the complete agreement of the parties and supersede any prior 
agreements or representations. DHS and the Grantee acknowledge that they have read the Modification 
and understand and agree to be bound by the terms and conditions of the existing agreement as 
modified by this action. This Modification becomes null and void if the time between the earlier 
dated signature and the later dated signature exceeds sixty (60) days, unless waived by DHS.
State of Wisconsin
Department of Health Services

Authorized Representative
Name: Title:
Signature:
Date:
Grantee
Entity Name:

Authorized Representative
Name: Title:
Signature:
Date:
DocuSign Envelope ID: F26357E6-0915-43C9-83F8-0093ACDE168A
Brent Miller
auk
Administrator
5/18/2023
Anna Benton
5/19/2023
 Assistant Administrator, Division of Public Health

DocuSign Envelope ID: F26357E6-0915-43C9-83F8-0093ACDE168A

CIVIL RIGHTS COMPLIANCE ATTACHMENT

The Wisconsin Department of Health Services and Grantee agree to the below change to the agreement. 
The below enumerated agreement revision is hereby incorporated by reference into the agreement and 
is enforceable as if restated therein in its entirety.

Section 10 of the Agreement (“CIVIL RIGHTS COMPLIANCE”) is hereby amended by inserting the 
following:

In accordance with the provisions of Section 1557 of the Patient Protection and Affordable Care Act 
of 2010 (42 U.S.C. § 18116), Title VI of the Civil Rights Act of 1964 (42 U.S.C. § 2000d et seq.), 
Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. § 701 et seq.), the Age Discrimination Act 
of 1975 (42 U.S.C. § 6101 et seq.), and regulations implementing these Acts, found at 45 C.F.R. 
Parts 80, 84, and 91 and 92, the Grantee shall not exclude, deny benefits to, or otherwise 
discriminate against any person on the basis of sex, race, color, national origin, disability, or 
age in admission to, participation in, in aid of, or in receipt of services and benefits under any 
of its programs and activities, and in staff and employee assignments to patients, whether carried 
out by the Grantee directly or through a Sub-contractor or any other entity with which the Grantee 
arranges to carry out its programs and activities.

In accordance with the provisions of Section 11 of the Food and Nutrition Act of 2008 (7 U.S.C. § 
2020), the Age Discrimination Act of 1975 (42 U.S.C. § 6101 et seq.), Section 504 of the 
Rehabilitation Act of 1973 (29 U.S.C. § 701 et seq.), the Americans with Disabilities Act of 1990 
(42 U.S.C. § 12101 et seq.), and Title VI of the Civil Rights Act of 1964 (42 U.S.C. § 2000d et 
seq.), and the regulations implementing these Acts, found at 7 C.F.R. Parts 15, 15a, and 15b, and 
Part 16, 28 C.F.R. Part 35, and 45 C.F.R. Part 91, the Grantee shall not discriminate based on 
race, color, national origin, sex, religious creed, disability, age, or political beliefs or engage 
in reprisal or retaliation for prior civil rights activity in any program or activity conducted or 
funded by the United States Department of Agriculture.

HIGH-RISK IT REVIEW

Pursuant to Wis. Stat. 16.973(13), Contractor is required to submit, via the contracting agency, to 
the Department of Administration for approval any order or amendment that would change the scope of 
the contract and have the effect of increasing the contract price. The Department of Administration 
shall be authorized to review the original contract and the order or amendment to determine whether 
the work proposed in the order or amendment is within the scope of the original contract and 
whether the work proposed in the order or amendment is necessary. The Department of Administration 
may assist the contracting agency in negotiations regarding any change to the original contract 
price.

Page 2 of 3 Template Revision: 02/02/2023 (previous templates no longer usable)

Page 1 of 3
Template Revision: 02/02/2023 (previous templates no longer usable)
CARS PAYMENT INFORMATION

DHS CARS STAFF INTERNAL USE ONLY
CARS PAYMENT INFORMATION
The information below is used by the DHS Bureau of Fiscal Services, CARS Unit, to facilitate the 
processing and recording of payments made under this Agreement.

Agency #:

Agency Name:

Agency Type:

CARS Contract Start
Date

CARS Contract End Date

Program Total Contract:

56   SAUK CO PHD

330       1/1/2023       12/31/2023             $3,888
Profile
Profile Note
Profile Current
ount
Profile Change
Amount
Profile Total
Amount
Funding Controls

154720

WIC

8

6-month
FARMERS MARKET
$3,888