SIMPLIFIED PURCHASE AGREEMENT (SPA)
MODIFICATION JUSTIFICATION
FROM:
Agency Name:
Authorizing Specialist:
Phone Number:
Email Address:
SUBJECT: Justification for Cost Adjustment to
To:
Original Cost:
Modification Charge:
*Total Revised Cost:
Reason for Adjustment:
New Delivery Date if Warranted:
This cost adjustment was negotiated and approved by our agency (sign and date below).
_______________________________________________________
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_
______
_____________
Authorizing signature
Date
Send this signed form with the original signed SPA Work Order form to the vendor,
and to the SPA team at
Jacket Number
Purchase Order Number
BAC
Requisition Number
SPA Work Order Number
_____________________________________________________________ _____________________
Contractor signature
Date
*For ordering customer, the GPO surcharge will be in addition to this total.
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