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Statement of Work Page 10 of 10 <br />Proprietary and Confidential <br />APPENDIX A: CHANGE ORDER FORM <br />Agency:CO #: <br />Project Code:Date: <br />Contract ID: <br />Initiating Department: <br />Initiated By: <br />A. PROJECT CHANGE DESCRIPTION/TASK SUMMARY: <br />1. [Description of Change #1 – Issue details/scope impact, add as many as needed] <br />•Schedule impact: <br />•Resource impact: <br />•Cost impact: <br />2.Etc. <br />Total Project Schedule Impact: [Enter] <br />Total Project Resource Impact: [Enter] <br />Total Project Cost Impact: [Enter] <br />B. BILLING TERMS: <br />Please describe the method by which Accela may bill the customer. Typically for CO’s this is T&M. <br />C. EXPIRATION: <br />If this is a CO for a bucket of T&M hours there needs to be an expiration date <br />SIGNATURE AND ACCEPTANCE <br />The above Services will be performed in accordance with this Change Order/Work Authorization and the provisions <br />of the Contract for the purchase, modification, and maintenance of the Accela systems. The approval of this Change <br />Order will act as a Work Authorization for Accela and/or Agency to perform work in accordance with this Change <br />Order, including any new payment terms identified in this Change Order. This Change Order takes precedent and <br />supersedes all other documents and discussions regarding this subject matter. <br />Accepted By:Accepted By: <br />Accela, Inc. <br />By:By: <br />Print Name:Print Name: <br />Title:Title: <br />Date:Date: <br />Page 70 of 428