Appendix 4 – Statement of Work

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Date:

Agency/Division/Authorized User:_

Location Address:

Authorized User:_

Phone: Email:_

Contractor Name/Representative:

Contractor Phone: Contractor Email:_

Scope of Agreement Services rendered under contract #___________________ and this Statement of Work shall include Unarmed or Armed Security Guard Services as described within the Contract and RFB documents. The specific schedule, duties, and responsibilities of Security Guards assigned through this contract will be agreed upon between the Authorized End User and the Contractor selected to provide the services at the Authorized User’s location.

Date of Service Services shall be provided beginning through .

Note: ending date shall not go beyond the current term of Contract ______________________.

Type of Service Following the definitions and classifications in the contract documents, select one of the following to indicate type of security guard to be assigned to this location:

Hourly Rate for Service

Unarmed - Security Guard

Armed - Security Guard

The hourly rate billed for the Security Guard(s) assigned at this location as described herein shall be: $ .

Note: This hourly rate shall be equal to or LESS than the hourly rate posted on the rate sheet for Contract # _____________________ for the type of service selected.

If requested and authorized in writing by Authorized User Representative, Overtime and Holiday hours will be billed at the rate of $_ .

Schedule Define the work schedule for Security Guards assigned to this location.

Include details including days of week, start and end times, break and lunch information. Indicate whether or not services are required on State Holidays, weekends, special events, regular business hours, etc.

Assigned Guard shall contact the following Law Enforcement Agency in case of disturbance/emergency:

Appendix 4 – Statement of Work

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Duties Define hourly/daily/weekly duties for Security Guards assigned to this location including stationary posts, foot or vehicle patrols, visitor management, package and delivery acceptance/coordination, video camera monitoring, etc.

Uniform Specifications Select one of the following. See RFB/Contract for descriptions.

Duty Uniform Corporate/Executive Uniform Other:

Special Requirements Use this space for any special requirements this location.

Additional Information:

Authorized User and Contractor agree to the terms herein and understand this agreement is a sub-agreement of State of Wisconsin Contract #_________________, and therefore subject to the terms and conditions of said contract.

Authorized User Representative Name:

Title:

Signature:

Date:

Contractor Representative Name:

Title:

Signature:

If Assigned Guard will be ARMED, approval of Division of Capitol Police must be verified by signature below.

Capitol Police Representative Name:

Title

Signature

Please send any questions/concerns about this form to the Contract Manager at the State Bureau of Procurement.