Contract Approval Request Form
To Be Completed by Requesting Department (#1-21)
1) Date of Request: 6/18/2024
2) Contract Type: Expense
3) Renewal Contract: No
4) Department Name: Facilities
5) Department Contact: Veronica Van Horn
6) Description: Change Order 4 for League City Annex Renovation decrease contract sum and pay final cost accounting invoice
7) PEID No: 717728
8) Req No:
9) Orgkey: 2901 179137
10) Object Code: 5782000
11) Vendor: Durotech
12) Vendor Contract No: CM20320
Expenditure Budget/Revenue Projections
13) Fund Name: American Rescue Plan Stimulus
14) Fund #: 2901
15) Current Year Budgeted:
16) Current Year Projected: $55,522.62
17) Year 2:
18) Year 3:
19) Year 4:
20) Year 5:
21) Totals:
To Be Completed by Purchasing Department
22) Contract Start Date: 6/14/2021
23) Auto Renewal Contract: No
24) Bid No: b211013
25) Contract End Date: 6/30/2023
26) Contract # Issued by Purchasing Department: CM20320
NOTES: