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Technology Assessment Statement of Work # 31362 v 1.0 <br />Orange County Government May 11, 2021 <br />Rev. 09/20Q INSIGHT PROPRIETARY AND CONFIDENTIAL Page 10 of 10 <br />9. ATTACHMENT – CHANGE REQUEST SAMPLE <br /> <br />CHANGE REQUEST FORM <br />CHANGE REQUEST # <br />Client Original Project Name Original SOW <br />Number <br /> <br />Insight Services Manager Client Project Sponsor Request Date <br /> <br />Purchase Order to Apply to Changes: State/Federal Contract Reference (if applicable) <br /> <br />Change Request Summary <br />Original Scope Task <br />Reason for Change <br />Description of Change <br />Project Schedule <br />Project Pricing <br />Deliverables <br />Signatures <br />This is a sample CR - not for execution. <br /> <br />DocuSign Envelope ID: 0CDC9D0A-E5D0-4A30-8BB9-83E7961EC2E2