Attachment H Sample Work Order~1.doc
DOC document 79 KB Posted
- Attached to
- Medical & Related Services
- Solicitation number
- 99SWC-S107
- Issued by
- Churchill County, Nevada
About this file
This document is a sample Work Order template for the State of Nevada Department of Administration Purchasing Division. It outlines the requirements for a contract to provide health services training by two certified trainers. The Scope of Work details the specific duties and tasks to be performed, and the Budget section provides an example of the requested expense categories and total estimated cost. The contract includes terms and conditions regarding State of Nevada employee assignments, travel expenses, and other requirements.
The related state and local contract opportunity is for Medical & Related Services in the state of Nevada. The Work Order template provided would be used to initiate a specific task or project under this broader contract vehicle. Pricing terms, set asides, funding sources, and other details are not explicitly provided in this sample document.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Attachment B Submission Letter.pdf | ||
| RFQ 99SWC-S107 Medical and Related Services.docx | DOCX document | |
| Attachment D Contract~1.docx | DOCX document | |
| Section 3 Background Information Sheet~3.pdf | ||
| Vendor Information Sheet.pdf | ||
| ATTACHMENT F Certification Regarding Lobbying~1.docx | DOCX document | |
| Attachment C Professional Qualification.pdf | ||
| Attachment E Insurance~1.docx | DOCX document | |
| List of Services updated 4-25-18.docx | DOCX document | |
| Attachment A 99SWC-S107.docx | DOCX document |
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Text version
Brian Sandoval Governor
STATE OF NEVADA
DEPARTMENT OF ADMINISTRATION
Purchasing Division 515 East Musser Street, Suite 300│Carson City, Nevada 89701
Phone: (775) 684-0170 │ Fax: (775) 684-0188
Patrick Cates Director Jeffrey Haag Administrator
Date: Enter Date Choose a vendor Work Order
For Choose an item.
Short Description: Give a brief description of the project for this work order. Example – Health services training by two certified trainers.
| Work Order #: |
| WO# |
| Total Cost: |
| $XX.XX |
| Budget Acct: |
| BA # |
| Start Date: |
| Start date |
| Category: |
| Cat # |
| Job Number: |
| Job # |
| End Date: |
| End date |
| GL: |
| GL# |
DUNS & Bradstreet #: For federal funding
SCOPE OF WORK:
Insert Scope of work. Describe the work needed and, if applicable, the specific duties of each party. Add any additional agency requirements.
Vendor name and Program name reserve the right to modify the specific tasks as necessary to accomplish the project goal.
BUDGET: (This table is an example of the requested format.)
Source of Funds: Name of Grant or GFUND % of Funds: % CFDA: # or N/A Federal Grant #: # or N/A
| Expense Type |
| Expense Calculation |
| Total Cost |
| 1. Travel |
| $ |
| 2. Operating |
| $ |
| 3. Supplies |
| $ |
| 4. Other/Admin |
| $ |
| Total Estimated Expenses: |
| $ |
Other Requirements:
In accordance with NRS 333.705, as amended, no current employee of the state of Nevada, or former employee with less than two years having expired since the termination of the person’s employment with the State, shall be assigned to perform work on any portion of this contract with the State. This prohibition applies equally to any sub-contractors that may be used to perform the requirements of the contract. The provisions of this section do not apply to the employment of a former employee of an agency of this State who is not receiving retirement benefits under the Public Employees’ Retirement System (PERS) during the duration of the contract.
Travel expenses, per diem, and other related expenses must conform to the procedures and rates allowed for State officers and employees. It is the Policy of the Board of Examiners to restrict Contractors/Subrecipients to the same rates and procedures allowed State Employees. The State of Nevada reimburses at rates comparable to the rates established by the US General Services Administration, with some exceptions (State Administrative Manual 0200.0 and 0320.0).
This space intentionally left blank
| Independent Contractor’s |
| Date |
Independent Contractor’s Title
| State of Nevada Authorized |
| Date |
Title
Note: This document should not contain any red text when completed.
File details come from the government source that posted it. Updated .