Contract Approval Request Form
To Be Completed by Requesting Department (#1-21)
1) Date of Request: 1/12/2024
2) Contract Type: Expense
3) Renewal Contract: No
4) Department Name: Professional Service
5) Department Contact: Sergio Cruz
6) Description: FY24 1ST AMENDMENT FOR ADDITIONAL FINANCIAL ASSISTANCE FUNDING
7) PEID No: 716084
8) Req No:
9) Orgkey: 1101440100
10) Object Code: 5481000
11) Vendor: St. Vincent’s House
12) Vendor Contract No: CM21369
Expenditure Budget/Revenue Projections
13) Fund Name: General Fund
14) Fund #: 1101440100
15) Current Year Budgeted: $160,000
16) Current Year Projected: $30,000
17) Year 2:
18) Year 3:
19) Year 4:
20) Year 5:
21) Totals:
To Be Completed by Purchasing Department
22) Contract Start Date: 11/29/2021
23) Auto Renewal Contract: No
24) Bid No: B212033A
25) Contract End Date: 9/30/2024
26) Contract # Issued by Purchasing Department: CM21369
NOTES: