Contract Approval Request Form
To Be Completed by Requesting Department (#1-21)
1) Date of Request: 4/8/2024
2) Contract Type: Expense
3) Renewal Contract: No
4) Department Name: Road & Bridge
5) Department Contact: Lee Crowder
6) Description: Reinforced Concrete Pipe
7) PEID No: 709399
8) Req No:
9) Orgkey: 2370 296100
10) Object Code: 5353013
11) Vendor: Coburn Supply
12) Vendor Contract No:
Expenditure Budget/Revenue Projections
13) Fund Name: Flood Control
14) Fund #: 2370
15) Current Year Budgeted:180,000
16) Current Year Projected: 30,000
17) Year 2: 30,000
18) Year 3: 30,000
19) Year 4: 30,000
20) Year 5: 30,000
21) Totals: 30,000
To Be Completed by Purchasing Department
22) Contract Start Date: 4/15/2024
23) Auto Renewal Contract: No
24) Bid No: B242011
25) Contract End Date: 4/14/2025
26) Contract # Issued by Purchasing Department: CM24154
NOTES: - HB1295 Requested