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DocuSign Envelope ID:88577424-D976-4534-82EF-EEA3A41BAB2A <br /> APPENDIX A-1 CHANGE ORDER <br /> Client: <br /> Date: <br /> Change Requested By: Phone: <br /> Project/Service Name: <br /> Account Manager: <br /> Change Requested: <br /> Action Required: <br /> Projected Impact: <br /> Impact(High, Medium,Low): Importance to Completion(High,Medium,Low): <br /> Effect on Schedule(Extension, Reduction,No Effect): <br /> Original Completion Date: New Completion Date: <br /> Notes: <br /> Additional Resources Required: <br /> Resource Name Hours Cost Expenses Totals <br /> Totals: <br /> Authorization: <br /> Client hereby authorizes Carolinas IT to proceed in accordance with this Change Order and is still governed by the <br /> terms and conditions of the original document referenced above. Note: No work is to be done on the change(s) <br /> until this Change Control form is approved. A revised copy of the project plan will be provided if applicable. <br /> Signature <br /> Client Name: Date: <br /> 792094c7-3c00-42b2-aa97-9219813651e8.docx <br /> Page 4 of 4 11/20/2017 <br />