Exhibit III_Change Order_WSB Ver II.pdf

PDF 171 KB Posted

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 .