WORK+ORDER+REQUEST+Form.docx

VENDOR WORK ORDER REQUEST

STATE OF NORTH DAKOTA

SFN 54383 (2-2020)

Agency Name

Work Order Request Number

Issue Date

Name of Agency Contact

E-mail Address

Telephone Number

Address

City

Work Order Requested Under State Contract (Insert Number)

Reference: In accordance with the terms and conditions of the State Contract noted above between State and Vendor, this Work Order Request authorizes delivery of the Deliverables described in accordance with the Scope of Work, Schedule, and terms specified below.

1. Scope of Work

a. Describe Scope of Work

b. Budget Available (if applicable)

2. Staffing Requirement

3. Agreement Type ☐Time and Materials ☐ Fixed Bid Project

4. Project Start Date

5. Project End Date

6. Schedule of Deliverables

7. Location of Work

8. Office Space Provided By ☐ Agency ☐ Vendor

9. Equipment Provided By ☐ Agency ☐ Vendor

10. Software Provided By ☐ Agency ☐ Vendor

11. Agency Project Manager

12. Vendor Project Proposal Due Date

13. Time and Status Reporting Systems to be Utilized by the Vendor (Mark all that apply)

Vendor Project Proposal: Vendor shall attach its proposal to this Work Order Request when responding. If Points are zero in 14. Evaluation Criteria, the information requested is optional as it will not be scored. The Vendor Project Proposal will include, at a minimum, the following items:

1. Vendor Project Proposal - Vendors must describe their strategy for accomplishing the work. Provide customer references for similar projects successfully completed, if available.

2. Qualifications and Availability of Vendor Staff - Provide the names and availability of staff who will work on the project. Provide the following documentation with the first work order for an agency. Provide updated documentation for subsequent work orders, if requested:

a. Resume(s) for Vendor staff

b. Reference checks for Vendor staff. Include the results of two reference checks that the Vendor has performed on the proposed individual, including the names and telephone numbers of the references. At least one reference must be from a previous employer or from a customer for which the Vendor staff performed IT contract services.

c. Background checks for Vendor staff. Vendor agrees that State may require contracted staff and subcontractors assigned by Vendor to perform work under this work order to submit to a criminal history record check in accordance with N.D.C.C. § 54-59-20 and §12-60-24. State shall have the right to reject any individual assigned to perform work under this work order if, in its sole discretion, it determines that the results of the criminal history record check make the individual unacceptable.

3. Cost - Provide a cost to match the requested Agreement Type above.

a. Time and Materials Proposals - Propose a Service Rate per hour for each proposed Vendor staff. If the Project dates span more than one year of the Contract term, provide rates for each effective year. Service rates may not exceed the rates originally proposed in response to this RFP; however the rates may be less.

b. Fixed Bid Proposals - Provide a fixed price to accomplish the Statement of Work.

Execution: The parties through their authorized agents have executed this Work Order Request and attached Vendor Project Proposal under terms of the above mentioned master agreement, subject to amendments in this Work Order, for the project price and on the dates set out below.

The total dollar contractual amount specified below for this Work Order and attached Project Proposal shall not be exceeded unless a written amendment is appended to this Work Order, duly executed by the authorized representative of both parties.

Total Contractual Amount

If Vendor is unable to bid this work order, please return the work order to requesting agency and provide the reason:

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