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)(jm), Stats.)
	
INITIATING PARTY OR PARTIES:	THE FILING FEE FOR FINAL AND BINDING ARBITRATION PURSUANT TO § 111.70(4)(jm), 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.  

All Information is Required
	
Name of 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 Initiating Party alleges that it and the other party 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 a hearing pursuant to § 111.70(4)(jm)2, Stats., to certify that an impasse exists in negotiations concerning a collective bargaining agreement between the parties.  Upon its certification of an impasse, Initiating Party requests that the Commission, pursuant to § 111.70(4)(jm)2, Stats., appoint an arbitrator to determine the terms of a collective bargaining agreement on which there is no agreement between the parties.

The Initiating Party further alleges the following, relevant to the status of the negotiations leading up to this petition:
	
Notice to Open Negotiations Was Served By 		Date Served		
Number of Times Parties Met for the Purposes of Negotiations Prior to Mediation		
Mediation 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