Vendor+Change+Order.docx
DOCX document 105 KB Posted
- Attached to
- IT - Professional Services Vendor Contract Pool
- Contract number
- 095-22ND
- Issued by
- North Dakota
About this file
This document is a Vendor Change Order form from the State of North Dakota (SFN 54385, dated 11-2017), designed to document modifications to an existing state contract. The form provides a template for vendors, agencies, and state representatives to formally request and approve changes to a current contract, with designated sections for describing the change request, its rationale, recommendations, and potential impacts.
The template allows for comprehensive documentation of proposed contract modifications, including sections for detailing the reasons behind the change, potential recommendations, impacts on cost, scope, schedule, and quality, and ultimately defining the most appropriate solution. The form requires signatures from both the vendor and the state agency, ensuring mutual agreement and official documentation of the contract amendment. While the specific contract details are not populated in this example, the form is structured to capture critical information about proposed changes to state contracts.
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Text version
VENDOR CHANGE ORDER
STATE OF NORTH DAKOTA
SFN 54385 (11-2017)
Work Order Requested Under State Contract (Insert Number)
Project Name
Work Order Number
Change Order Number
Agency Name
Vendor Name
Requested By
Request Description
Reasons/Goals for Change
Recommendations (Include recommendations by the party that is bringing the change request forward. There is a potential for multiple recommendations for solutions based on analysis.)
Impacts on Cost, Scope, Schedule, Quality (For each recommendation, a narrative of the impacts to cost, scope, schedule and quality should be included.)
Solution (Define the most appropriate solution to attain the desired objective. This is determined by the approving authority.)
Approval Signature(s) and Date(s). The project manager will identify the appropriate approval body and forward for final approval.
| State of North Dakota |
| Vendor |
| Agency Name |
| Vendor Name |
| Signature |
| Signature |
| Printed Name |
| Printed Name |
| Title |
| Title |
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