SIGNED FINAL 6-28-2022 Community_Testing_Support_EMERGENCY_63022__DHS

CONTRACT FOR SERVICES
between
State of Wisconsin Department of Health Services (DHS)
and

for
Community Testing Support Program (CTSP)

This Contract is between the State of Wisconsin Department of Health Services (DHS), at 1 West 
Wilson Street,

Madison, Wisconsin 53703, and at

ic Health
13
Contract ID Number: 435505-W22-FMB118

Contract Amount:     00

Contract Term: July 1, 2022 – June 30, 2023
DHS Contract Email: DHSTestingprogram@dhs.wisconsin.gov
Contractor Contract Administrator:

Contractor Email: Contractor FEIN:

n@sau
40
This Contract will become effective on the date of mutual execution by the parties’ authorized 
representatives. By signing below, the parties acknowledge that this Contract is executed with full 
knowledge of and agreement with the terms and conditions of this Contract. This Contract 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                     Contractor
Department of Health Services             Contractor Name:     
Authorized Representative              Authorized Representative Name:    

Title:   Title:

Administrator
Signature:   Signature:

Date:

022

Date:
DocuSign Envelope ID: 20E7DDE6-67EC-43C8-B1A6-5118841A2DF9
N

kcountywi.gov
Sauk County Public Health
6/28/2022
nty