Contract Amendment/PO Change/Task Order Request Form

City of Roswell Contract Amendment/PO Change/Task Order Request Form

Purchasing Department
Project Manager*
Purchasing Liaison or Admin Contact email
example@example.com
Project Manager E-mail*
PM Designated By Department Director
Department*
Dpt. Director E-mail*
example@example.com
Contractor / Supplier*
Contract Number or PO Number*
Type of Change Request*

Simple PO Change RequestContract Change Order/AmendmentTask Order Request
If Requesting a Contract Modification or Task Order, do you intend on creating a new PO, or modifying a currently issued PO to increase the overall value?

New POChange to Current POContract Amendment with not affect POOther
For initial Task Order requests utilize the original Not-To-Exceed amount of the underlying Task Order contract as the "Current Contract Value" and the amount of the requested task order should be placed in the "Requested Decrease" field. "Current Balance" should reflect how much of the original Task Order Contract Not-To-Exceed value is available for task orders.

Requests to Amend Task Orders already executed should follow the Contract Change Order Amendment process.
Current Contract Value
Please use $x,xxx.xx format
Current Balance
Please use $x,xxx.xx format
Requested Increase
Please use $x,xxx.xx format
Requested Decrease
Please use $x,xxx.xx format
Total New Amount
Annualize for Multi-Year terms.
Change requested by:

ContractorCity / Owner requested changeOther
Purpose of Contract Change Order / Amendment (Select all that apply)*

Extending the contract Period of PerformanceAltering the Statement of Work or SpecificationsPrice AdjustmentChange in QuantitiesChange in Payment TermsChange in Overall Contract ValueIncrease for Shipping CostsIssue Task OrderOther
Select any of the following characteristics that are true of the underlying Task Order Contract*

Involves Architecture or Engineering or related (i.e. survey) workMultiple contractors / consultants provide the same type of services (i.e. this is a multiple award contract).There is only one Contractor with a Task Order Agreement for this type of work.
How was professional selection determined? *
Multiple parties were available to provide the services, what non-cost/price factor made this consultant a better fit for the project? The Department Head will approve this determination.
Short Description of Problem/Reason for Requested Change*
Short but full description of why the modification or Task Order is required and what it will entail.
Steps undertaken to assure fair and reasonable pricing for changed work OR new task order*
A brief description of how price reasonableness was established for the requested change.
How many days should be added to the period of performance?*
(Days as a unit will have the same meaning as the contract regarding calendar or work days )
Upload Microsoft Word Addition/Change to, or Deletion from Statement of Work *

Upload a File

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Revised or Task Order Drawings / Plans

Upload a File
If too large to upload, upload a document with the path to a completed Drawings/plans location on the shared drive. Cancelof
Amount of Budgeted Funds Available for the Modification*
Base on current or submitted budget, annualized if for operations.
Change will be funded by*

Current PO budget line items.New Source or Sources.Change does not require additional funding.
Funding Story*
Imagine that you are explaining to a budget representative where the funds are coming from to fund your request.
Budget Org and Object Code*
Org - Object
Estimated Ongoing Annual Costs associated with Change (if any)
Think about licensing, cleaning, maintenance - if there will be no ongoing cost / operational cost, put $0.
Optional Additional Information Upload

Browse Files

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General Notes
Please make any general notes to Purchasing here.
Should be Empty: