Contract Approval Request Form
To Be Completed by Requesting Department (#1-21)
1) Date of Request: 7/1/2024
2) Contract Type: Expense
3) Renewal Contract: No
4) Department Name: Human Resources
5) Department Contact: Rebecca Gilliam
6) Description: “Partnership of Caring” with Marketplace Care Partners
7) PEID No: 723663
8) Req No:
9) Orgkey: 1101 155000
10) Object Code: 5481000
11) Vendor: Marketplace Care Partners
12) Vendor Contract No:
Expenditure Budget/Revenue Projections
13) Fund Name: Other Contract Services
14) Fund #: 5481000
15) Current Year Budgeted: $151,255.00
16) Current Year Projected: $151,255.00
17) Year 2:
18) Year 3:
19) Year 4:
20) Year 5:
21) Totals: $151,255.00
To Be Completed by Purchasing Department
22) Contract Start Date: 7/8/2024
23) Auto Renewal Contract: No
24) Bid No: B242013
25) Contract End Date: 7/7/2025
26) Contract # Issued by Purchasing Department: CM24153
NOTES: HB1295 On File - Bid awarded on CC 05/13/2024 item 74