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Professional/technical Work Order Certification Form - Minnesota Department Of Administration

PROFESSIONAL/TECHNICAL

WORK ORDER CERTIFICATION FORM

Submit to: Department of Administration, Materials Management Division, Professional and Technical Service Contracts,

112 Administration Building, 50 Sherburne Avenue, St. Paul, MN 55155. Contracts estimated to exceed $25,000 must also be

approved by the Office of Technology.

Certification Requirements: Required for all Work Order Contracts, in excess of $5,000 (Minn. Stat. 16C.08). Agencies should

submit TWO copies of this Certification Form. No work may begin before funds are encumbered and the work order contract is fully

executed.

Project Title:

State Project Manager:

RECS Project

ID.

Department: Administration

Division: Real Estate and Construction

Services

Estimated Cost:

Source of Funds: "Fund Number" "Dept ID"

"Appr Code"

Original Contract Period: From:

To:

With option to extend ____ add’l ___ yr.

periods

*Note: According to Minn. Stat. 16C.08 Subd. 3(5), the combined contract and amendment cannot exceed five years, unless otherwise provided for by law. The

term of the original contract must not exceed two years unless the commissioner determines that a longer duration is in the best interest of the state. If you are

requesting that the original contract length be longer than two years, please write a justification below:

*The total work order contract term cannot survive the expiration date of the Master Contract.

Agency certifies that Minn. Stat. § 15.061 allows Admin to enter into this professional/technical service contract.

Nature of Contract:

Product or Result: