Implementation Change Request

IMPLEMENTATION CHANGE REQUEST

This Implementation Change Request ("Request") is submitted pursuant to the Master Services Agreement or similar governing agreement between the parties. Client Name: and Contractor Name: hereby propose the changes set forth below. Request Date:

WHEREAS

WHEREAS, the parties currently perform work under an existing agreement (the "Agreement"); and

WHEREAS, Client has requested modifications to the implementation scope, schedule, or deliverables described in the Agreement; and

WHEREAS, Contractor has reviewed the requested modifications and has provided an assessment of impacts to cost, schedule, and performance which the parties intend to document by this Request.

REQUEST SUMMARY

SCOPE OF WORK

Provide a clear, detailed description of the change to implementation activities, deliverables, and acceptance criteria. Include any tasks to be added, modified, or removed. This scope will become an amendment to the Agreement upon execution by authorized representatives.

IMPACT ASSESSMENT

Describe impacts to schedule, resources, third-party dependencies, data migration, testing, and production cutover. Identify assumptions and constraints.

IMPLEMENTATION SCHEDULE

Proposed Implementation Start Date: Proposed Completion Date:

COST ESTIMATE AND PAYMENT TERMS

Estimated Labor Cost: $ Materials/Third-Party: $ Other: $

Invoice Submission Timing (days after milestone): Payment Due (days from invoice): Late Fee / Interest:

TERM AND TERMINATION

Change Effective Date: Anticipated End Date (if applicable):

Either party may terminate this Change Request for material breach of its terms if the breaching party fails to cure within days' written notice. Termination for convenience may be exercised upon prior written notice and payment for work performed to date.

Termination will not relieve Client of the obligation to pay for work performed and accepted through the termination date, nor relieve Contractor of confidentiality and data return obligations.

CONFIDENTIALITY

All information exchanged in connection with this Request that is designated confidential or that reasonably should be understood to be confidential given its nature or the circumstances of disclosure shall be subject to the confidentiality obligations of the Agreement. Confidentiality obligations survive termination of this Request for .

ADDITIONAL TERMS

Modification: This Request amends the Agreement only to the extent expressly stated herein. Except as modified by this Request, all terms and conditions of the Agreement remain in full force and effect. Conflicting provisions of this Request shall govern with respect to the subject matter of the change.

Billing Rates: Unless otherwise stated, additional work arising from this Request will be billed at Contractor's standard rates and subject to the payment terms set forth above. Client shall not unreasonably withhold approval of mutually agreed estimates required to effect the change.

GOVERNING LAW

This Request shall be governed by and construed in accordance with the laws of the jurisdiction of , without regard to conflict of law principles.

ENTIRE AGREEMENT

This Request, together with the Agreement and any other executed change orders, constitutes the entire agreement of the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous understandings and agreements, whether written or oral, relating to such subject matter. No amendment to this Request will be effective unless executed in writing by authorized representatives of both parties.

APPROVALS AND ACKNOWLEDGMENTS

By signing below, each party certifies that the individual signing on its behalf is duly authorized to bind the party, that the party accepts the terms of this Request, and that the parties will proceed with implementation in accordance with the terms set forth herein.

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