Vendor+Change+Order.docx
DOCX document 105 KB Posted
- Attached to
- IT - Professional Services Vendor Contract Pool
- Contract number
- 095-TECH
- Issued by
- North Dakota
About this file
This document is a Vendor Change Order template from the State of North Dakota, specifically form SFN 54385 (dated 11-2017), designed to facilitate modifications to existing state contracts. The template provides a structured format for documenting change requests, involving a state agency, a vendor, and an approving authority, with designated spaces for signatures and official documentation of proposed changes.
The template is explicitly structured to capture critical contract modification details, including the original state contract number, project name, work order number, and change order number. It requires comprehensive documentation of change request specifics, such as reasons, goals, recommendations, and potential impacts on cost, scope, schedule, and quality. The form culminates in defining the most appropriate solution, which is determined by the approving authority, and requires formal signatures from both the state agency and vendor representatives to validate the proposed changes.
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Text version
VENDOR CHANGE ORDER
STATE OF NORTH DAKOTA
SFN 54385 (11-2017)
Work Order Requested Under State Contract (Insert Number)
Project Name
Work Order Number
Change Order Number
Agency Name
Vendor Name
Requested By
Request Description
Reasons/Goals for Change
Recommendations (Include recommendations by the party that is bringing the change request forward. There is a potential for multiple recommendations for solutions based on analysis.)
Impacts on Cost, Scope, Schedule, Quality (For each recommendation, a narrative of the impacts to cost, scope, schedule and quality should be included.)
Solution (Define the most appropriate solution to attain the desired objective. This is determined by the approving authority.)
Approval Signature(s) and Date(s). The project manager will identify the appropriate approval body and forward for final approval.
| State of North Dakota |
| Vendor |
| Agency Name |
| Vendor Name |
| Signature |
| Signature |
| Printed Name |
| Printed Name |
| Title |
| Title |
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