ORBuys S-44300-00001995 OHA-RFA-5171 Final Form Price Agreement Attachment 1 WOC Sample.pdf

Price Agreement Number 000000 Work Order Number 00 Attachment 1- Work Order Contract Sample to Form Price Agreement Sample

STATE OF OREGON

WORK ORDER CONTRACT

In compliance with the Americans with Disabilities Act, this document is available in alternate formats such as Braille, large print, audio recordings, Web-based communications and other electronic formats. To request an alternate format, please send an e-mail to dhs-oha.publicationrequest@state.or.us or call 503-378-3486 (voice) or 503-378-3523 (TTY) to arrange for the alternative format.

This Work Order Contract (WOC) hereby incorporates by reference all of the terms and conditions contained in Price Agreement 000000 between the State of Oregon, Oregon Health Authority, hereinafter referred to as “OHA”, and

Contractor Address

City, State ZIP Telephone: (required) Facsimile: (required)

E-mail address (required) Hereinafter referred to as “Contractor.”

This WOC is effective on the date it is signed by all parties and all applicable approvals have been obtained.

The terms of this WOC along with all terms and conditions of the Price Agreement constitute the entire contract.

The terms of this WOC will not be waived, altered, modified, supplemented or amended, in any manner whatsoever, except by written amendment to this WOC signed by all parties.

Work Order summary:

Project Title: Review of Waiver and Hazard Assessment Requests Review Services

Project Start Date: Project End Date:

Project Location:

Work Order NTE Amount:

Catalog of Federal Domestic Assistance (CFDA) #(s) of federal funds to be paid through this WOC:

N/A mailto:dhs-oha.publicationrequest@state.or.us

Contractor shall deliver all services as described in the Price Agreement Statement of Work (“Services”) Exhibit A, Part 1 completing the attached Review of Waiver and Hazard Assessment Requests Review Form and be paid in accordance with the Price Agreement Payment and Financial Reporting Exhibit A, Part 2. Any other project-specific documents must be attached to this WOC.

OHA shall pay Contractor for accepted and approved Services. OHA will return incomplete invoices or invoices that do not comply with Exhibit A, Part 2 Payment and Financial Reporting to Contractor for correction.

Contractor, by signature of this WOC, certifies that they have not been party to the development of the document(s) they are to review under this WOC and have no other relationship, bias, and actual conflict of interest exists which will prevent Contractor from providing review services, specifically those who are regulated by the Toxic Free Kid Act.

Contractor, by signature of this WOC certifies they have read and understand the Non-Disclosure language in the Price Agreement and agrees to adhere to the requirements.

Contractor shall submit any correspondence and all invoices for completed Services under this Work Order Contract by email in PDF format to:

Public Health Division, Center for Health Protection and Environmental Public Health Section

Attn: Brett Sherry

Address: 800 NE Oregon Street Suite 640, Portland OR 97232

Phone: 971-673-0442 Fax: 971-673-0497

Email: brett.w.sherry@state.or.us

CONTRACTOR: YOU WILL NOT BE PAID FOR SERVICES RENDERED PRIOR TO NECESSARY

STATE APPROVALS.

Contractor, by signature on this WOC, hereby acknowledges that Contractor has read this WOC and the Price Agreement, understands it, and agrees to be bound by its terms and conditions.

Contractor Name By:

Authorized Signature Title Date State of Oregon, acting by and through its Oregon Health Authority By:

Authorized Signature Title Date Approved for Legal Sufficiency Not required per OAR 137-045-0030(1)(a) unless a WOC exceeds $150,000 total

Assistant Attorney General Date