Contract Approval Request Form
To Be Completed by Requesting Department (#1-21)
1) Date of Request: 4/30/2024
2) Contract Type: Expense
3) Renewal Contract: Yes
4) Department Name: Information Technology
5) Department Contact: Lauren Michaels
6) Description: SSL Wildcard Plus Certificate (1 yr)
7) PEID No: 703308
8) Req No: 1101
9) Orgkey: 159100
10) Object Code: 5419301
11) Vendor: SHI Govt Solutions
12) Vendor Contract No: DIR-CPO-5094
Expenditure Budget/Revenue Projections
13) Fund Name: General
14) Fund #: 1101
15) Current Year Budgeted: $3500
16) Current Year Projected: $1014.49
17) Year 2:
18) Year 3:
19) Year 4:
20) Year 5:
21) Totals:
To Be Completed by Purchasing Department
22) Contract Start Date: 5/15/2023
23) Auto Renewal Contract: No
24) Bid No: NA
25) Contract End Date: 5/14/2025
26) Contract # Issued by Purchasing Department: CM23276
NOTES: HB1295 on file