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f AmpliFund <br /> Change Request Form <br /> Project Information <br /> Customer City of Everett("COE") <br /> Project AmpliFund Implementation - Federal and State Programs <br /> Customer Project Manager Dorothy Claymore <br /> AmpliFund Project Manager Elvira Makarevich <br /> Change Name Subscription and Scope Change <br /> Date Submitted 07/06/2022 <br /> This change request is for Human Needs Custom Reports,the set up and configuration of COE's Federal and <br /> State Grants,and the adjustment of COE's subscription from AmpliFund Grant Seeker Advanced to AmpliFund <br /> Lifecycle <br /> Change Impacts <br /> Impacted Element Yes No Description of Change Impact <br /> Subscription X Updating to Lifecycle Advanced for no charge <br /> Objectives/Scope . X Scope described in this SOW <br /> Project Milestones X <br /> Deliverables X <br /> Cost X _ Additional 80 implementation services hours <br /> Other X <br /> Cost Estimate <br /> Cost Estimate Detail Estimated Cost <br /> Additional 80 implementation services hours @ $175.00 rate $ 14,000.00 <br /> Total Change Order Cost Estimate $14,000.00 <br /> Additional Services Hours Notes: <br /> • 50 hours allocated to complete the items listed in this Scope of Work. <br /> • 5 hours allocated for AmpliFund to host one (1) Applicant and one (1) Recipient training. <br /> • 25 hours allocated as a buffer to use for this scope of work,or any other implementation work needed <br /> by the City of Everett in the future. Hours expiration will align with contract renewals and will be <br /> extended as necessary to be used over multiple years. <br /> o AmpliFund will provide monthly service hourly reports <br /> Customer Reviewer Approvals/Status <br /> Customer Approval AmpliFund Approval <br /> Approver Name: CASSIE FRANKLIN Approver Name: Scott M. Smith <br /> Approver Role: MAYOR Approver Role: CEO <br /> Approver Signature: --•----- Approver Signature: <br /> Approved Date: I Approved Date: 8/1/2022(07-1...-7___ <br /> 3 <br /> ral APPROVED AS TO FORM <br /> ii <br /> OFFICE OF THE CITY ATTORNEY T Page 1 of 5 <br /> EVERETT R 7.--2.---.. <br /> tty Clerk <br />