Contract Approval Request Form
To Be Completed by Requesting Department (#1-21)
1) Date of Request: 1/29/2024
2) Contract Type: Expense
3) Renewal Contract: Yes
4) Department Name: Information Technology
5) Department Contact: Misty Witmer
Description: Keeper Password Security Management with SCW submitted by Information Technology.
6) PEID No: 701326
7) Req No: FR404169
8) Org key: 1101159100
9) Object Code: 5419301
10) Vendor: SCW
11) Vendor Contract No: TIPS 230105
Expenditure Budget/Revenue Projections
12) Fund Name: General Fund
13) Fund #: 1101
14) Current Year Budgeted: $4000.00
15) Current Year Projected: $2246.91
16) Year 2:
17) Year 3:
18) Year 4:
19) Year 5:
20) Totals:
To Be Completed by Purchasing Department
21) Contract Start Date: 2/5/2024
22) Auto Renewal Contract: No
23) Bid No: NA
24) Contract End Date: 2/4/2025
25) Contract # Issued by Purchasing Department: CM24141
NOTES: - HB1295 Requested