ESBD_489546_1770939185152_SOL_EXH_F.4_Change Order Request Form.pdf

OGC Template Approved 2/1/2021 Page 1 of 4

Change Order Request Form

1. Overview

This Change Order Request Form (CORF) defines the detailed requirements of certain incorporated services and enhancements already within the scope of the originally awarded Contract. This CORF will be incorporated by reference into an Amendment or Purchase Order Change Notice (POCN). DPS will not accept any work or pay Contractor for that work without a signed Amendment or an issued POCN.

DPS Project Manager (DPS PM), Contract Monitor, and Contractor will estimate the work effort for this request by completing the fillable sections with information specific to the particular work the Contractor will perform. Contractor may not change this form in any way from what was incorporated into the original Contract. Contractor may only enter data in the fillable fields in Section 2.

2. Scope

DPS requires Contractor to provide the services detailed in this section. Contractor must identify services related to achieving the agreed-upon deliverables. This CORF will address the processes, sub-tasks, itemized costs, and duration for completion of each deliverable, and the pricing will set the associated cost. Tables 1, 2, 3, and 4 are provided as the tools to clearly itemize all identified deliverables.

Services are not complete until all testing is successfully completed and DPS gives final acceptance as defined in the Contact. During the testing and acceptance period, Contractor must capture and document performance issues identified by Contractor or reported by DPS and resolve all hardware, software, and programming defects. Contractor may not bill DPS for time and materials used to resolve defects.

Describe the itemized services and specific business and functional requirements required. This information must match with all tables in this section.

Table 1—Project Points of Contact and Responsibilities

Organization Title and Responsibility

Name Phone Number Email Address

DPS Project Sponsor

DPS Project Manager

DPS

Technical SME;

Hardware

DPS

Software

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Data transmission

Contract Administrator

DPS Contract Monitor

Organization Title and Responsibility

Name Phone Number Email Address

Contractor Relationship Representative

Contractor Project Manager

Contractor Programmer

Contractor DBA

Contractor

Hardware

Contractor

Software

Table 2—Project Specific Roles and Responsibilities

Roles and Responsibilities Contractor DPS

Project requirement and dependency #1

Project requirement and dependency #2

*primary (P)

Table 3—Project Schedule

No. Deliverable Description Due Date Comments

Table 4—Pricing

Deliverable Description

Service Category and Description (e.g., Programmer) and Employee Name

Quantity of Hours

Hourly Rate in Contract

Cost Extension

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3. Risk and Issue Management

If there is no DPS PM associated with this Change Order Request, then the Contract Monitor will be responsible for the DPS PM tasks listed within this section. The following general procedure will be used to manage an active Change Order’s issues and risks.

3.1. DPS PM will identify and document project issues (current problems) and risks (potential events that impact the project).

3.2. DPS PM will assess, analyze, and prioritize the impact and determine the highest priority risks and issues that will be managed actively, according to priority, by Contractor.

3.3. Contractor must plan and schedule high-priority risks and issues assigning responsibility for risk management and issue resolution in a documented risks and issues log, as determined by DPS.

3.4. Contractor must track and report the status of risks and issues, and communicate risk mitigation plans and issue resolutions in a documented risks and issues log.

3.5. DPS PM will monitor and control the effectiveness of the risk and issue management actions.

3.6. Active issues and risks will be monitored and reassessed on a weekly basis by DPS PM and

Contractor. Mutually agreed upon escalation and risk management processes will be defined at the outset of initiating the CORF.

4. Required Reporting and Communication

Contractor must do the following.

4.1. Create and maintain a documented risks and issues log.

4.2. Provide DPS PM with a weekly written progress report for each in-process Change Order. Reports will be submitted by close of business the following Monday of each week throughout the life of an active Change Order. Contractor may submit the progress report by email.

4.3. Provide one monthly status report; and, if requested by DPS, prepare and lead one status meeting per week of no more than one hour in duration.

4.4. Attend any DPS-required or requested meetings, or submit any DPS-requested documentation.

5. Pricing and Scope

Contractor’s scope, pricing, service categories, and employee types must match the Mandatory Pricing Schedule incorporated into the Contract. If Contractor did not specify the specific employees in the Contract, Contractor

OGC Template Approved 2/1/2021 Page 4 of 4 must identify the specific employee names in Table 4 of those employees providing the work associated with this specific CORF.