Contract Approval Request Form
To Be Completed by Requesting Department (#1-21)
1) Date of Request: 9/9/2024
2) Contract Type: Expense
3) Renewal Contract: Yes
4) Department Name: County Clerk
5) Department Contact: Mae Ross
6) Description: DataCard CD800
7) PEID No: 712592
8) Req No:
9) Orgkey: 2102114020
10) Object Code: 5423000
11) Vendor: IdentiSys, Inc
12) Vendor Contract No: CM24014
Expenditure Budget/Revenue Projections
13) Fund Name: RMP
14) Fund #: 2102
15) Current Year Budgeted: 1,500.00
16) Current Year Projected: 1,128.00
17) Year 2:
18) Year 3:
19) Year 4:
20) Year 5:
21) Totals:
To Be Completed by Purchasing Department
22) Contract Start Date: 10/1/2024
23) Auto Renewal Contract: Yes
24) Bid No: NA
25) Contract End Date: 9/30/2025
26) Contract # Issued by Purchasing Department: CM24303
NOTES: HB1295 Requested