Exhibit III_Change Order_WSB Ver II.pdf
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- Attached to
- Master Agreement AZ|CTR053110
- Contract number
- CTR053110
- Issued by
- Arizona
About this file
This document is a Task Order Scope of Work Change Request form (Exhibit III) from WSB (likely a government agency or department), designed to facilitate modifications to an existing task order under specific contract terms. The form provides a standardized template for documenting and authorizing changes to a task order, with designated spaces for task order number, contractor name, change request date, and contract number.
Section 11.1 of the document outlines the process for revising task orders in the event of unforeseen circumstances. When revisions are deemed necessary, both parties must provide written documentation detailing additional tasks, schedules, and specific reasons for changes. The form requires firm fixed all-inclusive pricing for any additional services, and mandates that the change order be executed with authorized signatures from both the DPS/WSB Manager and the Contractor Job Authorization Designee. The primary purpose of this document is to formalize and track modifications to an existing contract in a structured, transparent manner.
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Text version
Exhibit III
Task Order Number Contractor Name
Requested By Reviewed By
Change Request Date Contract Number
Additional tasks, schedules, and basis for the revisions per 11.1
Firm fixed all-inclusive pricing to perform additional services
TERMS FOR UNFORESEEN CIRCUMSTANCES
11.1. WSB may allow for task order revisions the event of unforeseen circumstances. Should WSB determine that revisions to original task order offers are necessary, written documentation detailing the additional tasks, schedules and basis (specific reasons) for the revisions along with additional firm fixed all-inclusive pricing to perform the additional services specified shall be executed (signed by both parties) for processing as a direct release purchase/ change order.
DPS/WSB Manager or Authorization Designee Contractor Job Authorization Designee
Authorized Signature Authorized Signature
Printed Name and Badge No. Printed Name and Title
File details come from the government source that posted it. Updated .