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DocuSign Envelope ID:7DCC2B8A-E44C-4172-BF52-8A8B6D647BED <br /> 35 <br /> EXHIBIT A <br /> CHANGE ORDER FORM <br /> This Change Order Number_ is made as of in reference to that certain Statement of <br /> Work No. _ entered into by and between Farragut Systems, Inc. ("Farragut') and <br /> ("Customer") dated which is subject to the Master Services Agreement between <br /> the parties. <br /> For: <Change Order Title> <br /> I. Change Request <br /> Description of Proposed Change: <br /> Business Reason for Proposed Change: <br /> Change Request submitted by: _Customer _Farragut <br /> Name: Signature: <br /> Title: Date: <br /> II. Analysis of Change <br /> Fee Impact: <br /> Change in Project Schedule: <br /> Other Considerations: <br /> III. Approval or Denial <br /> If not approved by both parties within 10 days of submission, this change request will be deemed <br /> denied. <br /> Approved: <br /> Denied: <br /> Farragut Systems, Inc. Customer: <br /> By: By: <br /> Name: Name: <br /> Title: Title: <br /> Date: Date: <br /> -25- <br />