State of Wisconsin
Employment Relations Commission
2418 Crossroads Drive, Suite 1000, Madison, WI  53718-7896
Phone:  608-243-2424    Fax:  608-243-2433
Email:  werc@werc.state.wi.us	

PETITION FOR FINAL AND BINDING ARBITRATION
(Pursuant to § 111.70(4)(cg)6, Stats.)
	
INITIATING PARTY OR PARTIES:	THE FILING FEE FOR INTEREST ARBITRATION PURSUANT TO § 111.70(4)(cg)6, STATS. IS $800 SPLIT EQUALLY BETWEEN BOTH PARTIES.  PROCESSING BEGINS WHEN A PETITION AND $400 IS RECEIVED, AT WHICH TIME THE OTHER PARTY IS BILLED BY THE COMMISSION FOR THE REMAINING $400.	
	Labor Organization		
	Employer		
	Joint		

Complete and submit this form and, at the same time, serve a copy on the other party, if not filed jointly.  Please also submit a copy of the preliminary final offer(s).  The other party shall, within fourteen (14) calendar days of the Commission’s receipt of the Petitioner’s preliminary final offer, submit its responsive preliminary final offer to the Petitioner and the Commission.
	
All Information is Required	
Name of Employee or Labor Organization	Name of Employer	
		
Street Address, City, State, Zip Code	Street Address, City, State, Zip Code	
		
Telephone No.	Email Address	Telephone No.	Email Address	
				
Name of Representative	Name of Representative	
		
Street Address, City, State, Zip Code (if different)	Street Address, City, State, Zip Code (if different)	
		
Telephone No.	Email Address	Telephone No.	Email Address	
				
The parties allege that they have reached a deadlock after a reasonable period of negotiations and after mediation by the Wisconsin Employment Relations Commission and request the Commission to conduct an investigation pursuant to § 111.70(4)(cg)6, Stats., and determine whether arbitration should be initiated.

The parties allege the following, relevant to compliance with the requirements of §§ 111.70(4)(cg)1, 2, 3, and 6 (first paragraph), Stats.:	
Notice to Open Negotiations Was Served By 		Date Served		
Date(s) Proposal(s) Were Exchanged in Open Meetings		
Number of Times Parties Met for the Purposes of Negotiations Prior to Mediation		
Mediation(s) Was Conducted By 		Date(s) of Mediation		
Select Applicable Statement:	
 There is an existing collective bargaining agreement
 There is not an existing collective bargaining agreement	Date collective bargaining agreement expires		

The parties jointly request the following Commissioner or WERC Staff Member be assigned to this matter.

I declare that I have read the contents of this petition and that the statements it contains are true and correct to the best of my knowledge.
	
Name		Title		
Signature		Date