Work+Order+Request.docx

LAND TITLE SERVICES – AGENCY WORK ORDER

Instructions Complete the agency contact information at the top of the form.

· Suggested format for Work Order Request Number is agency department # - two-digit year – two-digit sequence number for the work order, for example 112-15-01.

· Issue date is the date you are sending the Work Order Request to the vendor.

1. Statement of Work – Include information that tells the vendor what is to be done including the desired outcome. Be as specific and comprehensive as possible. Do not assume the vendor will know something or do something if you do not include it in the Statement of Work. You may choose to attach the Statement of Work as an attachment. Specific services covered under the master contract include (see actual contract if you need more detail):

a. Leasing/Easement Surface Title Work

b. Leasing/Easement Mineral Title Work

c. Current Owner Search

d. Institutional Lender Search

e. Deed Report

f. Mortgage Report

g. Single Index Research

h. Curative Title Work

i. Surface Use, Damage, Reclamation, Restoration Negotiations, Lease and Right of Way Acquisitions

j. Curative title work, surface damage negotiations, lease acquisition, and right of way acquisitions

2. Project Start Date – Specify the date when work is to start.

3. Required Completion Date – Specify the date when the services as defined in Statement of Work (#1) is to be completed.

4. Is On-site Work Required – Determine if any agency on-site work is required by listing Yes or No. If yes, provide the location address.

Execution

· Fill in the “Number of Hours to Complete Statement of Work Shall Not Exceed”. You may need to talk with the vendor before completing that section to determine the number.

· Both parties must sign and date using the signature blocks in the Execution section of the work order form.

STATE CONTRACT #003 – LAND TITLE SERVICES

WORK ORDER REQUEST

AGENCY NAME

WORK ORDER REQUEST NUMBER

ISSUE DATE

AGENCY CONTACT

E-MAIL ADDRESS

TELEPHONE NUMBER

ADDRESS

CITY

STATE

ZIP CODE

REFERENCE: In accordance with the terms and conditions of the State Term Contract #003 Land Title Services master contract between STATE and CONTRACTOR, this Work Order Request authorizes delivery of the Deliverables described in accordance with the Statement of Work, Schedule, and terms specified below.

1. STATEMENT OF WORK AND ANY SPECIFIC DELIVERABLES (attach extra sheets if necessary):

2. PROJECT START DATE

3. REQUIRED COMPLETION DATE

4. IS ON-SITE WORK REQUIRED AT THE AGENCY LOCATION (YES OR NO)

IF YES- LIST THE LOCATION ADDRESS

EXECUTION: The parties through their authorized agents have executed this Work Order Request under the terms of the Land Title Services master contract, subject to amendments in this Work Order.

The total number of hours specified below for this Work Order shall not be exceeded unless a written amendment is appended to this Work Order, duly executed by the authorized representative of both parties.

NUMBER OF HOURS AGREED UPON TO COMPLETE STATEMENT OF WORK:

STATE OF NORTH DAKOTA

VENDOR

SIGNATURE

SIGNATURE

PRINTED NAME

PRINTED NAME

TITLE

TITLE

DATE

DATE