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Request No: <br />Request Date: <br />Requested By: <br />Assigned To: <br />Client: <br />1W ID /Project. <br />Description <br />Describe the desired modification to the Services and how this falls outside the original scope. Be as specific as <br />possible. <br />Effort <br />Describe the amount of work that will be required to implement this change with, estimated hours. If this is for <br />custom programming, include level of effort to update the technical specification, develop the code and unit <br />test. <br />Requirement Additional Hours Estimate & Rate cost Expected Completion <br />L + <br />Impact <br />Describe other project areas that could be impacted because of this change and any additional testing that may <br />need to be performed. <br />Authorization <br />I understand that these enhancements are outside the scope of work described in the Statement of Work <br />(SOW) identified above. On behalf of the Client listed above, 1, the undersigned, authorize implementation of <br />this Change Request in accordance with the estimate provided herein. <br />In accordance with my Company's purchasing policies: <br />(Please select one option) <br />— a new Purchase Order will not be issued to cover the additional fees associated with this change in <br />scope. I am authorized by my Company to approve payment for these additional fees. <br />a new Purchase Order will be issued. The PO will be sent to Aquitas Solutions. <br />The original Purchase Order will be amended for the additional funds. The amendment to the PO will be <br />sent to Aquitas Solutions. <br />Signature Date Printed Name <br />South Bend Maximo Migration to MaaS Page 18 of 36 Confidential <br />