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									32100 INFORMATION TECHNOLOGY
                                                                                  AGENCY CONTRACT NO.
PURCHASED SERVICES WORK CONTRACT
STATE OF WASHINGTON
INSERT AGENCY NAME (AGENCY)                                                          GA REFERENCE NO.
By signing below the customer and the contractor acknowledge that this Work Contract is issued under the provisions of the Office of State
Procurement 32100 IT Services Primary Agreement Program. The services authorized are within the scope of services set forth in the Purpose of this
contract. All rights and obligations of the parties shall be subject to and governed by the terms and conditions, amendment(s) (if applicable), and the
signed 32100 Primary Agreement including any subsequent modifications, are hereby incorporated by reference.
Purpose




                                                      (Attach additional sheets if necessary)
Statement of Work




Deliverables and Due Date:


                               Deliverables are subject to review and approval by AGENCY prior to payment.
                                                   (Attach additional sheets if necessary)

Start Date                                                                        End Date
                                                                       Budget
     Description / Task                                                                 Quantity       Unit (Hrs.)    Unit Cost              Total
1.                                                                                                                    $                 $
2.                                                                                                                    $                 $
Business Objective Supported:                                                  AGENCY shall pay an amount not to exceed                 $

                                                                     Cost Codes
  Prog Index           Org Code                 Fund                 Appn Index              Object          Sub-                  Dollars
                                                                                                            Object



Both the Agency and the Contractor are responsible for ensuring work performed is within the scope of this Work Contract. The
Agency must monitor proper compliance with the terms of this Work Contract and applicable statutes and regulations. IN
WITNESS WHEREOF, the parties have executed this Work Contract.
INSERT CONTRACTOR NAME                                                            AGENCY APPROVAL
ADDRESS
CITY STATE ZIP
FEDERAL ID NUMBER




                    (Signature)                             (Date)                          (Signature)                            (Date)
W/C Manager                                                (Print Name)           W/C Manager                                       (Print Name)
Telephone No.                                                                     Telephone No.
Email:                                                                            Email:
GA Acknowledgement
Signature:                                                           Date:
GA Coordinator:                                                      Email:                                      Phone:

								
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