BPM005278 Exhibit C_Sample Task Order Form.pdf

Task Order Form

TMDL and Watershed Modeling and Application

Contract No:

Effective Date:

Contract Terms and Conditions: This TO with the Contractor’s Scope of Work and Monthly Performance Reports

(MPRs) herewith shall constitute the Contract between the parties and supersede all other understanding, oral or written. It is issued pursuant to the original Contract and shall be governed by the Terms and Conditions contained therein, in full force and effect.

Site Name: ________________________________________

Task Order Expiration Date: ______________________

Scope of Work: This TO shall be performed pursuant to:

Contract Number: _______________________

Total Task Order Cost Amount: _________________________

All Correspondence, Deliverables and Invoices between the Contractor and ______ shall be sent to:

Using Agency PM: Name, Position, Email, and Phone

Contractor PM: Name, Position, Email, and Phone

Invoices: Accounts Payable, AccountsPayable@azdeq.gov

Documents to be submitted as attachments to this TO are:

Detailed Scope of Work (SOW)

Monthly Performance Report (MPR)

CONTRACTOR hereby acknowledges receipt and understanding of the above TO Agreement, and shall adhere to the approved clarification documents submitted.

Contractor Signature: Printed Name:

Title/Position: Date: