Exhibit D_Change Order Template.docx
DOCX document 27 KB Posted
- Solicitation number
- RFP-122771
- Issued by
- Richmond City, Roanoke City, Virginia
About this file
This is a Change Order Template document for the Virginia Department of Education's Child Nutrition Information Management System procurement (RFP 201-26-040). The template is designed to formalize modifications to the awarded contract and establishes the standard process for requesting, evaluating, and implementing changes to the scope of work, deliverables, timelines, or other contract terms. The template requires detailed documentation of the change request, including a description of the requested modification, the justification for the change, and identification of which contract sections are affected. It specifies fields for tracking the change order number, submission date, and affected line items or deliverables, ensuring that all parties maintain clear records of contract amendments throughout the project lifecycle.
The Change Order Template includes provisions for pricing adjustments associated with requested modifications, requiring cost impact analysis and approval signatures from authorized representatives of both the contractor and the Virginia Department of Education. The template establishes a structured review and approval workflow to ensure that changes are evaluated for feasibility, budget impact, and alignment with project objectives before implementation. This standardized approach allows for transparent documentation of scope changes and associated cost or schedule impacts, enabling both the agency and contractor to maintain contract compliance while accommodating necessary modifications during the system implementation and operational phases.
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Text version
Contract No. VA-201-26-040, Exhibit D
EXHIBIT D – SOW CHANGE ORDER TEMPLATE
Change Order No. XXX for Statement of Work C-X Between (NAME OF AGENCY/INSTITUTION) and (SUPPLIER NAME)
Issued Under
CONTRACT NUMBER VA- XXXX-XXXX
BETWEEN
VIRGINIA INFORMATION TECHNOLOGIES AGENCY
AND
(SUPPLIER NAME)
This Change Order No. XXX hereby modifies and is made an integral part of Statement of Work C-X (the “SOW”), between NAME OF AGENCY/INSTITUTION (“Authorized User”) and NAME OF SUPPLIER (“Supplier”), which was issued under Contract Number VA-XXXX-XXXX (“Contract”) between the Virginia Information Technologies Agency (“VITA”), on behalf of the Commonwealth of Virginia and Authorized Users, and Supplier.
[[Note: Instructions for using this template to draft a Change Order are in gray and enclosed in double brackets [[ ]]. These instructions should be deleted after the appropriate text has been added to the Change Order. Contractual language is not in gray and should remain in the document. Text that is highlighted in blue is contractual language that is variable based on the nature of the project and in final form should not be highlighted. Agency/Institution should remove the first two lines of the heading, which pertain to this template as an Exhibit to the VITA Contract and remove the Exhibit reference from the header.]]
CHANGE ORDER
This is Change Order No. XXX to SOW C-X issued by Authorized User to Supplier under which Supplier is to provide the Authorized User with a Authorized User Project Name Solution (“Solution”).
The following item(s) is/are hereby modified as follows: [[Note: Include only the sections of the SOW that are being changed. Do not include sections not being modified. Changes should be clearly identified as “From” (copy/paste from current SOW section) and “To” (fully describe the change(s) to the referenced section). Here is an example, using SOW section 1.]] Period of Performance
The following change is made to the Period of Performance:
[The duration of the Period of Performance is increased by four (4) months.] The following is changed with respect to the Period of Performance:
From: twelve (12) months of execution of this Statement of Work To: sixteen (16) months of execution of this Statement of Work
This Change Order No. XXX is issued pursuant to and, upon execution, shall become incorporated in the SOW C-X, which is incorporated in the Contract. In the event of conflict, the following order of precedence shall apply:
1. The Contract, including Exhibit A
1. Statement of Work C-X, as amended by this and previous Change Orders, with the more current Change Orders superseding older Change Orders.
The foregoing is the complete and final expression of the agreement between the parties to modify the SOW and cannot be modified, except by a writing signed by duly authorized representatives of both parties hereto.
ALL OTHER TERMS AND CONDITIONS OF THE REFERENCED SOW REMAIN UNCHANGED.
By signing below, the authorized parties agree to the terms of this Change Order No.XXX to SOW C-X, effective (INSERT EFFECTIVE DATE).
| Supplier | Authorized User | |
| By: ________________________________ | By: __________________________________ | |
| (Signature) | (Signature) | |
| Name: _____________________________ | Name: _______________________________ | |
| (Print) | (Print) | |
| Title: ______________________________ | Title: _________________________________ | |
| Agency Head or Designee | ||
| Date: ______________________________ | Date: _________________________________ |
SOW CHANGE ORDER TEMPLATE Q04FY2019 Page 2 of 2
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