ADD, DELETE OR SUBSTITUTE CONTRACTOR STAFF REQUEST FORM Date Project Name Agreement Number Contractor Name Contractor Contact Person Contractor Phone No. Meets Contract Staff To Be Added Email Staff Role Hourly Rate requirements Date Staff To Be Deleted Email Reason Effective Reason: Reason: Reason: Reason: Comments/Special Instructions Please note: The changes as indicated in this request are being made at no additional cost to the State. Acceptance Contractor Acceptance Division/Project Contractor (If other than an individual, state whether a corporation, partnership, etc.) By (Authorized Signature) By (Authorized Signature) Printed Name of Person Signing Printed Name of Person Signing Title Date Date
ADD, DELETE OR SUBSTITUTE CONTRACTOR STAFF REQUEST FORM Project Name Agreement Number Date Contractor Name Contractor Contact Person Contractor Phone No. Staff To Be Added Email Staff Role Hourly Rate Meets Contract requirements Staff To Be Deleted Email Date Effective Reason Reason: Reason: Reason: Reason: Comments/Special Instructions Please note: The changes as indicated in this request are being made at no additional cost to the State. Acceptance Contractor Acceptance Division/Project Contractor (If other than an individual, state whether a corporation, partnership, etc.) By (Authorized Signature) By (Authorized Signature) Printed Name of Person Signing Printed Name of Person Signing Title Date Date
CWDS_Add_Delete_Or_Substitute_Contractor_Staff_Request_Form.docx