Contract Approval Request Form
To Be Completed by Requesting Department (#1-21)
1) Date of Request: 6/17/2024
2) Contract Type: Expense
3) Renewal Contract: No
4) Department Name: Facilities
5) Department Contact: Veronica Van Horn
6) Description: Elevator repair to records storage building
7) PEID No: 719809
8) Req No:
9) Orgkey: 1101 170100
10) Object Code: 5424000
11) Vendor: Otis Elevator Company
12) Vendor Contract No: QTE-001924334
Expenditure Budget/Revenue Projections
13) Fund Name: General
14) Fund #: 1101
15) Current Year Budgeted:
16) Current Year Projected: $3,044.12
17) Year 2:
18) Year 3:
19) Year 4:
20) Year 5:
21) Totals:
To Be Completed by Purchasing Department
22) Contract Start Date: 6/24/2024
23) Auto Renewal Contract: No
24) Bid No: NA
25) Contract End Date: 6/23/2025
26) Contract # Issued by Purchasing Department: CM24228
NOTES: HB1295 Requested