[Example: Create your own version and remove this note and the footer before using]

Professional Services Agreement (PSA) STATEMENT OF WORK

This Statement of Work (“SOW”) is for the purchase and provision of Services and Deliverables under the Professional Services Agreement referenced below. Capitalized terms not defined in this SOW have the meanings given in the Professional Services Agreement.
Professional Services Agreement: Professional Services Agreement between [Customer] and [Provider] dated as of XXX
SOW #:
SOW Effective Date:
SOW Term: ___ days from the Effective Date
SPECIFICATIONS
Description of Services [Describe or attach or link to reference document]
Description of Deliverables [Describe or attach or link to reference document]
CUSTOMER DEPENDENCIES (See Section 3.2 of Professional Services Agreement)
Customer Dependency: Description: Due Date: if any Notes:
       
       
ACCEPTANCE (See Section 3.4 of Professional Services Agreement)
Deliverable: Due Date: Subject to Acceptance: (Y/N) Notes:
       
       
THIRD-PARTY MATERIALS (See Section 5.2 of Professional Services Agreement)
Third-Party Materials (List any Third-Party Materials included in Deliverables)
Open Source: (List and include complete license and copyright attribution information for any Open Source included in Deliverables)
Open Source under a Copyleft License: (Specify if Open Source provided under a Copyleft License is permitted by Customer and, if so, list)(See Section 5.3(c) of Professional Services Agreement)
RIGHTS IN DELIVERABLES (See Section 6 of Professional Services Agreement)
All Deliverables are [Licensed Deliverables][Assigned Deliverables] in accordance with the selection made by the parties under Rights in Deliverables on the Cover Page to the Professional Services Agreement, except for any exceptions specified below.
Exceptions: The following Deliverables will be treated as specified below:
Licensed Deliverables:
Assigned Deliverables:
Reserved Materials: (If there are any Assigned Deliverables, list any Reserved Materials)
COMMUNICATION AND ESCALATION (See Section 4 of Professional Services Agreement)
Customer: Provider:
Project Lead Name and Email Name and Email
Escalation Lead Name and Email Name and Email
CUSTOMER MATERIALS (See Section 8 of Professional Services Agreement)
Customer Materials: Describe (if any)
Customer Systems: Describe (if any)
Customer Facilities: Describe (if any)
FEES & EXPENSES (See Section 10 of Professional Services Agreement)
Fees:
Expenses:
INVOICES
Invoice To:
Invoice Contact Name:

Invoice Address:

Invoice Email:
PO Required on Invoice: Yes or No

If yes, PO #: _______________
Accepted and agreed to as of the SOW Effective Date by the authorized representative of each party:
Customer: Provider:
Signature:

Name and Title:

Company:

Address (choose one or both):
Email:
Postal mail:

Date:
Signature:

Name and Title:

Company:

Address (choose one or both):
Email:
Postal mail:

Date: