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State - Task Order

State of:
Department / Agency:
SECTION 1: TASK ORDER SUBMISSION DETAILS
:

Item Details
Date Submitted:
:

Task Order Priority Indicate Task Order Priority "yes" or "no"
Detailed Description:
Alternatives (alternative approach):
Change Control Board Review Date:
:

Type of Task Order Indicate Task Order Type "yes" or "no"
:

Warranty Indicate Warranty Period "yes" or "no"
SECTION 2: TASK ORDER IMPACT ANALYSIS
Task Order Hours & Rates:

Resource Type Rate Hours Total
Deliverables (if applicable):

Deliverable Title Description Submission Date
State Responsibilities - if applicable, specify task(s) which will be supported by the State for this task order:

Task Description
SECTION 3: TASK ORDER APPROVAL
:

Approval Indicate Task Order Approval "yes" or "no"
Signature:
Project Director:
Date:

Item	Details

Task Order Priority	Indicate Task Order Priority "yes" or "no"

Type of Task Order	Indicate Task Order Type "yes" or "no"

Warranty	Indicate Warranty Period "yes" or "no"