Attachment 13 - SAMPLE Project Change Request Form.pdf

KATHY HOCHUL

Governor

DRU RAI

NYS Chief Information Officer

RFP # C000979 Salesforce Implementation EA Attachment 13 – Project Change Request Form

Project Change Request PCR2___-________ to ________ SOW

By signing below, Enter Company Name (“SALESFORCE Consulting Partner”) and the New York State (“NYS”) Office of Information Technology Services (“ITS”) agree to change the ITS/Enter Company Name Technical and Operational Support Services Statement of Work No. NYS ITS ###, dated Click or tap to enter a date (“ C000979 Services SOW”), and any applicable terms, as follows:

1. Change in Scope:

This Change Authorization No. PCR-____________ (“PCR”), is issued pursuant to the C000979 Services SOW and Salesforce Implementatio Enterprise Agreement, Contract No. C000979 (“Agreement”), ITS and Salesforce Consulting Partner affirm and agree that through course of conduct and mutual agreement of the parties, the term of the C000979 Services SOW has been extended until Click or tap to enter a date..

Description of Change:

This PCR modifies and documents the C000979 Service SOW's extension from Click or tap to enter a date through Click or tap to enter a date. The planned annual spend for Enter Company Name resources and the estimated hours for Fiscal Year Select FY are described below in this PCR. The Enter Company Name resources work on various NYS ITS Data Center Projects.

These resources provide services to ITS on a Time and Materials basis.

The changes in this PCR modify the original C000979 Services SOW Section 1.8 Estimated Charges, specifically subsections 1.8.1 and 1.8.2. All other Terms and Conditions of the C000979 Services SOW will remain in effect.

The resources described in this PCR will provide Services according to the Terms and Conditions (assumptions, responsibilities, deliverables, and completion criteria) of the referenced C000979 Services SOW, and the C000979 Agreement.

2. Changes to Estimated Schedule

(Insert description of estimated changes to schedule)

Ex: No schedule changes will occur to the C000979 Services SOW as a result of this PCR.

3. Charges Resulting from PCR2-_______: $Enter dollar amount per year

DRU RAI

NYS Chief Information Officer

RFP # C000979 Salesforce Implemetation EA Attachment 13 – Project Change Request Form

For ITS FY Select FY , Enter Company Name estimates that the Charges for hourly Services are estimated to be $Enter dollar amount per year. The total hours for Services is estimated at Enter total # hours of services per year at the hourly rates listed in the table that follows, Hourly Model Pricing.

4. Hourly Model Pricing: Implementation and Professional Services

PCR2_

Skill Category Model Quantity Estimated Annual Hours

20___ Rate

Annual Funding Total

1 Principal Engagement Manager

- 1 xx $xx.xx $ Enter $ amt

2 Engagement Manager - 1 xx $xx.xx $ Enter $ amt

3 Salesforce CTO - 1 xx $xx.xx $ Enter $ amt

4 Senior Business Strategy Consultant

- 1 xx $xx.xx $ Enter $ amt

5 Business Strategy Consultant

- 1 xx $xx.xx $ Enter $ amt

6 Senior Project Manager

- 1 xx $xx.xx $ Enter $ amt

7 Project Manager - 1 xx $xx.xx $ Enter $ amt

8 Principal Solution Architect

- 1 xx $xx.xx $ Enter $ amt

9 Senior Solution Architect

- 1 xx $xx.xx $ Enter $ amt

10 Solution Architect - 1 xx $xx.xx $ Enter $ amt

11 Principal Technical Architect

- 1 xx $xx.xx $ Enter $ amt

12 Senior Technical Architect

- 1 xx $xx.xx $ Enter $ amt

13 Technical Architect - 1 xx $xx.xx $ Enter $ amt

14 Senior Developer - 1 xx $xx.xx $ Enter $ amt

15 Developer - 1 xx $xx.xx $ Enter $ amt

DRU RAI

NYS Chief Information Officer

RFP # C000979 Salesforce Implementation EA Attachment 13 – Project Change Request Form

PCR2_

Skill Category Model Quantity Estimated Annual Hours

20___ Rate

Annual Funding Total

16 Solution Consultant - 1 xx $xx.xx $ Enter $ amt

17 Associate Solution Consultant

- 1 xx $xx.xx $ Enter $ amt

18 Technical Consultant - 1 xx $xx.xx $ Enter $ amt

19 Associate Technical Consultant

- 1 xx $xx.xx $ Enter $ amt

20 Quality Assurance Lead

- 1 xx $xx.xx $ Enter $ amt

21 Quality Assurance Consultant

- 1 xx $xx.xx $ Enter $ amt

22 Quality Assurance Associate

- 1 xx $xx.xx $ Enter $ amt

23 Principle Human Centered Change Consultant

- 1 xx $xx.xx $ Enter $ amt

24 Senior Human Centered Change Consultant

- 1 xx $xx.xx $ Enter $ amt

25 Human Centered Change Consultant

- 1 xx $xx.xx $ Enter $ amt

26 Experience Architect - 1 xx $xx.xx $ Enter $ amt

27 Experience Designer - 1 xx $xx.xx $ Enter $ amt

Subtotal $ Enter $ amt

Total $ Enter $ amt

DRU RAI

NYS Chief Information Officer

RFP # C000979 Salesforce Implementation EA Attachment 13 – Project Change Request Form

Each of us agrees that the complete agreement between us about this transaction consists of: (a) this Change Authorization No. PCR2_- ; (b) Enter Company Name /ITS Technical & Operational Support Services Statement of Work No. NYS ITS ### dated Click or tap to enter a date (above referred to as the " C000979 Services SOW"); and (c) the ITS and Salesforce Implementation Enterprise Agreement, Contract No. C000979. It is understood and agreed that this PCR is placed under the terms and conditions of Agreement # C000979 between Enter Company Name and ITS, as amended, and that the provisions of that Agreement supersede any inconsistent provisions of this PCR.

This PCR is executed pursuant to the terms of the ITS/ Salesforce Implementatio Enterprise Agreement No. C000979.

Enter Company Name agrees to provide the Services described in this PCR provided ITS accept this PCR by signing in the space below. By signing, each signatory affirms they have received appropriate internal approvals to do so. For the ITS signatory, this requires written internal approval on an ITS Internal Review Form including at minimum approvals by representatives from ITS COE, ITS Finance, ITS Procurement and Contract Services, and ITS Division of Legal Affairs.

Agreed to: Agreed to:

NYS Office of Information Technology Services Enter Company Name By:

Authorized signature

By:

Authorized signature

Name (type or print): Name (type or print):

Date: Date:

STATE OF NEW YORK )

) SS:

COUNTY OF ALBANY )

On this day of , 20 , before me personally came , to me known, who, being duly sworn by me, did depose and say that (s)he resides in

; that(s)he is the (the President or other officer or director or attorney-in-fact duly appointed) of Enter Company Name the corporation described in and which executed the above instrument; and that (s)he signed her/his name thereto by authority of the board of directors of said corporation.

NOTARY PUBLIC

DRU RAI

NYS Chief Information Officer RFP # C000979 Salesforce Professional Services EA

Attachment 13 – Project Change Request Form

ITS/SALESFORCE Professional Services Enterprise Agreement Contract No. C0000979: EMERGENCY TASK ORDER No.: 20-

An "emergency" per the terms of the ITS/ Salesforce Professional Services Enterprise Agreement Contract No. C000979 is defined as "an urgent and unexpected requirement where health and public safety or the conservation of public resources is at risk."

1. ITS has declared the following Emergency:

2. Enter Company Name Emergency Services Needed:

On Click or tap to enter a date at ##:## Select AM/PM the following ITS authorized signatory:

ITS Name:

ITS Title:

ITS Phone Number:

ITS Email Address:

authorized Enter Company Name to immediately perform the following emergency services for ITS:

-- reporting on or about Click or tap to enter a date at ##:## Select AM/PM at the following emergency operations site:

DRU RAI

NYS Chief Information Officer RFP # C000979 Salesforce Professional Services EA

Attachment 13 – Project Change Request Form

Emergency Location Site:

3. ITS Emergency Contact

The requested Enter Company Name personnel will report to the following ITS emergency operations site contact person(s) who will direct Enter Company Name ‘s staff while on site and determine when Enter Company Name emergency services are no longer needed:

ITS Emergency Contact Name:

ITS Emergency Contact Title:

ITS Emergency Contact Phone Number:

ITS Emergency Contact Email:

4. Estimated Titles/Hours

List the estimated Enter Company Name titles to be used in the implementation of this emergency task order and the estimated total number of hours required.

Emergency Project Titles to be used:

Total Estimated Hours:

5. Actual Arrival Times and Departures of Enter Company Name Staff, if known:

Enter Company Name Staff Title and Name

Date Arrived Time Arrived Date Departed Time Departed

Click or tap to enter a date

##:## Select

AM/PM

Click or tap to enter a date

##:## Select

AM/PM

Click or tap to enter a date

##:## Select

AM/PM

Click or tap to enter a date

##:## Select

AM/PM

Enter Text Here

DRU RAI

NYS Chief Information Officer RFP # C000979 Salesforce Professional Services EA

Attachment 13 – Project Change Request Form

Written approval: As required in ITS/ Salesforce Professional Services Enterprise Agreement Contract No. C000979, this ETO must be signed in writing either during or after the declared emergency by an the ITS authorized signatory with written internal approval on an ITS Internal Review Form including at minimum approvals by representatives from ITS Data Center, ITS Finance, ITS Procurement and Contract Services, and ITS Division of Legal Affairs.

Agreed to by NYS-ITS Agreed to by Enter Company Name

By:

Authorized Signature

By:

Authorized Signature