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: Yes
4) Department Name: Contract Services
5) Department Contact: Veronica Van Horn
6) Description: Letter renewal for FY24 funding for Gulf Coast Transit District
7) PEID No:
8) Req No:
9) Orgkey: 1101 440100
10) Object Code: 5496150
11) Vendor:
12) Vendor Contract No:
Expenditure Budget/Revenue Projections
13) Fund Name: General
14) Fund #: 1101
15) Current Year Budgeted:
16) Current Year Projected: $100,000.00
17) Year 2:
18) Year 3:
19) Year 4:
20) Year 5:
21) Totals:
To Be Completed by Purchasing Department
22) Contract Start Date: 10/1/2023
23) Auto Renewal Contract: No
24) Bid No: NA
25) Contract End Date: 9/30/2024
26) Contract # Issued by Purchasing Department: CM20407
NOTES: HB1295 is not required