Change Order Form (Template)

1. Change Order Metadata

Change Order Number[CO-YYYY-###]

Date Requested[DATE]

Requested By[NAME, TITLE, PARTY]

Related MSAMSA dated [DATE]

Related SOW[SOW NUMBER & DATE]

Project Name[PROJECT NAME]

2. Change Classification

Mark all that apply:

[ ] Scope Change [ ] Timeline Change [ ] Budget Change [ ] Technical Change

[ ] Compliance Change [ ] Security Change [ ] Third-Party Platform Change [ ] Emergency Change

3. Description of Requested Change

[Describe the requested change in plain language.]

4. Business Reason for Change

[Explain why the change is needed.]

5. Current Approved Scope

[Summarize the relevant currently approved scope from the SOW.]

6. Proposed Revised Scope

[Describe the scope as it will read after this change.]

7. Deliverables Affected

[List affected Deliverables.]

8. Features Added

[List features/capabilities added.]

9. Features Removed

[List features/capabilities removed.]

10. Technical Architecture Impact

[Describe impact on architecture, integrations, hosting, data flows.]

11. AI System Impact

Prompt Changes[None / describe]

Model Changes[None / describe]

Retrieval Source Changes[None / describe]

Guardrail Changes[None / describe]

Human Review Changes[None / describe]

AI Disclosure Changes[None / describe]

12. Data Protection Impact

New Personal Information[None / describe]

New Sensitive / Regulated Data[None / describe]

New Subprocessors[None / describe]

New Data Transfers[None / describe]

Retention Changes[None / describe]

Required DPA Updates[None / describe — update Exhibits as needed]

13. Communications Compliance Impact

New Channel[None / SMS / MMS / RCS / WhatsApp / Voice / Email]

New Consent Language[None / describe — requires Client legal review]

New Message Templates[None / describe]

New Opt-Out Method[None / describe]

Platform Registration Impact[None / 10DLC/brand / WhatsApp template approval]

14. Security Impact

[Describe any change to security posture, access, or controls.]

15. Accessibility Impact

[Describe any change affecting accessibility conformance.]

16. Legal or Regulatory Impact

[Describe any new legal/regulatory considerations (e.g., new state privacy law applicability, AI disclosure rules).]

17. Assumptions

[State assumptions underlying this change.]

18. Client Dependencies

[List access, approvals, content, or data Client must provide for this change.]

19. Schedule Impact

New Milestones[Describe]

Delayed Milestones[Describe]

Launch Date Impact[Describe]

20. Fee Impact

Additional Fixed Fees[$AMOUNT]

Additional Hourly Fees[HOURS × $RATE = $AMOUNT]

Third-Party Costs[$AMOUNT — pass-through]

Usage Fees[$AMOUNT / estimate]

Change to Monthly Maintenance[$AMOUNT / MONTH (if any)]

TaxesClient responsible for applicable taxes

Total Change in Fees[$TOTAL]

21. Acceptance Criteria for the Change

[Define how the change will be accepted.]

22. Testing Requirements

[Describe testing for the change.]

23. Rollback Plan

[Describe how the change can be reverted if needed.]

24. Risks and Mitigation

[Identify risks and mitigations.]

25. Approval Conditions

[Any conditions to approval (e.g., receipt of deposit, platform approval).]

26. Rejection or Deferral Notes

[If rejected or deferred, note reasons and date.]

27. Authorized Signatures

By signing, the parties agree this Change Order amends the referenced SOW and is governed by the MSA.

CA SOLUTIONS LLC[CLIENT LEGAL NAME]

SignatureSignature

Name / TitleName / Title

DateDate

28. Internal Implementation Checklist (CA Solutions internal use)

Step Owner Done

Update SOW / scope record [PM] [ ]

Update project plan & milestones [PM] [ ]

Update billing / invoicing [Finance] [ ]

Update DPA exhibits / subprocessors (if needed) [Lead] [ ]

Update consent / messaging config (if needed) [Lead] [ ]

Confirm platform registrations (if needed) [Lead] [ ]

Notify team & archive executed CO [PM] [ ]

29. Attachment Log

# Attachment Reference

1 [e.g., revised mockups] [Ref]

2 [e.g., updated data flow] [Ref]

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