Attachment_5_Work_Authorization_Form.docx

This is a Work Authorization Form (Exhibit A) template used by a state agency to document and authorize specific tasks or deliverables under an existing contract. The form serves as an administrative tool to track work authorization numbers, task titles, and deliverable summaries, along with project timelines and resource allocation. The document requires completion of key project information including start and completion dates, total labor hours, and total cost estimates. Signature lines are provided for both the agency division coordinator (or designee) and the contractor to authorize and acknowledge the work scope.

The form is a standard template that does not specify contract-unique details, pricing, or deliverable information. Rather, it functions as a reusable authorization document to be completed on a per-task or per-project basis within the framework of an existing master contract. The template includes fields for the contract number reference, work authorization number, agency name, and title/role identification for both authorizing parties. This Work Authorization Form would be populated with specific details as individual tasks or work orders are assigned under the broader contract agreement between the state agency and contractor.