Contract Approval Request Form
To Be Completed by Requesting Department (#1-21)
1) Date of Request: 4/18/2024
2) Contract Type: Expense
3) Renewal Contract: No
4) Department Name: Sheriff’s Department
5) Department Contact: Douglas Hudson
6) Description: Psychological Examinations & New Hire Examinations
7) PEID No: 722018
8) Req No:
9) Orgkey: 1101211133
10) Object Code:5412101
11) Vendor: Vincent Ruscelli, Ph.D.
12) Vendor Contract No:
Expenditure Budget/Revenue Projections
13) Fund Name: Sheriff-Corrections
14) Fund #: 1101211133
15) Current Year Budgeted: 12,000
16) Current Year Projected: 20,400
17) Year 2:
18) Year 3:
19) Year 4:
20) Year 5:
21) Totals:
To Be Completed by Purchasing Department
22) Contract Start Date: Click or tap to enter a date.
23) Auto Renewal Contract: Choose an item.
24) Bid No:
25) Contract End Date: Click or tap to enter a date.
26) Contract # Issued by Purchasing Department:
NOTES: