AD HOC INTEREST ARBITRATOR’S FEE AND EXPENSE REPORT
(Pursuant to § 111.70(4)(cg), Stats.)
	
Arbitrator Name		
INT/ARB No.		
Employer Name		
Employer Address		
Labor Organization Name		
Labor Organization Address		
Date of Order Appointing Single Arbitrator		
Date of Order Appointing Arbitrator Panel		
Date(s) of Public Hearing Pursuant to Citizen Petition		
Date(s) of Mediation		
Location of Mediation		
Resolved in Mediation?	
  Yes
  No	
Was a Transcript Taken?	
  Yes
  No	
If Yes, Date Transcript Received		
Were Briefs Filed?	
  Yes
  No	
If Yes, Date Last Brief Was Received		
Offer Selected	
  Employer
  Labor Organization	
Date of Award		
Fees	
    Daily Per Diem Fee		
    Travel		
    Expenses		
    Award Preparation		
Total Fees		
Amount Payable by Employer		
Amount Payable by Labor Organization		
Date of This Report		
Signature		

Interest awards shall be e-mailed immediately upon issuance to the Commission.  PLEASE ATTACH A COPY OF THE AWARD TO THIS FEE AND EXPENSE REPORT, IF ANY, AND MAIL, FAX OR EMAIL TO THE WISCONSIN EMPLOYMENT RELATIONS COMMISSION, 2418 CROSSROADS DRIVE, SUITE 1000, MADISON,  WI 53718-7896, FAX: 608-243-2433, EMAIL: WERC@WERC.STATE.WI.US