State to Complete. The State’s Project Manager for this Services Request is: Name: Address: Phone: Fax: Work Order Details:
State to Complete. The State’s Project Manager for this Services Request is: Name: Address: Phone: Fax: OCCM Request No. Date of Submission of OCCM Request: / / Contractor Required Proposal Date (5 Business Days following date of receipt): / / Work Order Details: Description of Work Requested: Is the Work to be provided on a Deliverables Basis? Yes No Requested Dates of Performance: Start of the Work: / / Completion of the Work: / / How is the Work Order to be Paid for? Fixed Price Basis Time and Materials Not to Exceed Basis
State to Complete. The State’s Project Manager for this Services Request is: Xxxx X. Xxxxxx, AIA, Manager, Quality Compliance Facilities Services | Operations and Programs Division Judicial Council of California 0000 Xxxxxxx Xxxx Xxxxx, Xxxxx 000, Xxxxxxxxxx, XX 00000-0000 Direct 000-000-0000 | Cell Phone 000-000-0000 | Fax 000-000-0000 xxxx.xxxxxx@xxx.xx.xxx | Charge Code: 0000-00000000-0000-00-00-0000 Date of Service Request: XX/XX/20XX Date Proposal is Due: XX/XX/20XX Email Proposals to: Work Order Details: Court Name: Location: Bldg #: Project Name: Description of Work Requested ***Scope goes here*** Is the Work to be provided on a Deliverables Basis? Yes No Agreed to Dates of Performance: Start of the Work: XX/XX/20XX Completion of the Work: XX/XX/20XX How is the Work Order to be Paid for? Fixed Price Basis Time and Materials Not to Exceed Basis Vendor to Complete: Please complete the below schedule of charges: Example Schedule of Charges Personnel Rate per Hour Expected Hours Expected Hourly Cost Executive Principals $ 0.00 Principals $ 0.00 Senior Engineer $ 0.00 Engineers $ 0.00 Designers $ 0.00 CADD Specialist $ 0.00 Mileage Authorized IRS reimbursement rate Incident Expenses (Reproduction, Processing, Postage, Delivery, etc) Allowance for Travel Expense (See Appendix B) Subconsultant - Labor $0.00 Hotel N/A Airfare/Car N/A Not to Exceed Cost The Vendor’s Project Manager for this Work Order shall be: Name: Address: Email: Phone: (000) 000-0000 Fax: (000) 000-0000 Total Estimated Hours: Total Estimated Fee: List the staff individuals who will provide services for this project: Designated Subcontractor(s): Date of Vendor’s Proposal: XX/XX/20XX For Vendor’s Use Only For JCC Use Only Date: Date: Submitted by: Authorized by: Authorized by: APPENDIX G WORK ORDER FORM (SAMPLE) JUDICIAL COUNCIL OF CALIFORNIA STANDARD AGREEMENT COVERSHEET WORK ORDER WORK ORDER NUMBER TBD FEDERAL EMPLOYER ID NUMBER TBD
State to Complete. The State’s Project Manager for this Services Request is: Name: ____________________________ Address:___________________________ Phone: ____________________________ Fax: _____________________________ OCCM Request No. ______ Date of Submission of OCCM Request: __/__/__ Contractor Required Proposal Date (5 Business Days following date of receipt): __/__/__ Work Order Details: Description of Work Requested: ______________________________________________________________________________________________ ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Is the Work to be provided on a Deliverables Basis? Yes No Requested Dates of Performance: Start of the Work:__/__/__ Completion of the Work: __/__/__ How is the Work Order to be Paid for? Fixed Price Basis Time and Materials Not to Exceed Basis
State to Complete. The State’s Project Manager for this Services Request is: Name: ____________________________ Address:___________________________ Phone: ____________________________ Fax: _____________________________ OCCM Request No. ______ Date of Submission of OCCM Request: __/__/__ Contractor Required Proposal Date (5 Business Days following date of receipt): __/__/__ Task Order Details as Furthr Described in Attached Documents: Description of Work Requested:
State to Complete. The State’s Project Manager for this Services Request is: Name: ____________________________ Address:___________________________ Phone: ____________________________ Fax: _____________________________ OCCM Request No. ______ Date of Submission of OCCM Request: __/__/__ Contractor Required Proposal Date (5 Business Days following date of receipt): __/__/__ Services Request Details: The State shall attach, to this Services Request: A set of requirements describing in full all modifications to Appendix A - Modular Building Specifications as provided in the RFP that the State wishes to have incorporated into Modular Building Unit. The location where the Modular Building Unit will be located and any site details applicable to the installation. The Lease Option that the State Wishes to Use: [Check One] 5-year lease with an option to purchase or 10-year lease with an option to purchase. Any Other Details Pertinent to this Service Request: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Required Dates of Performance: Start of the Work:__/__/__ Start of Installation at the Site __/__/__ Completion of the Work: __/__/__
