Contract Approval Request Form
To Be Completed by Requesting Department (#1-21)
1) Date of Request: 10/1/2024
2) Contract Type: Expense
3) Renewal Contract: No
4) Department Name: Professional Services
5) Department Contact: Sergio Cruz
6) Description: FY25 INITIAL FINANCIAL ASSISTANCE AWARD
7) PEID No: 716084
8) Req No:
9) Orgkey: 1101440100
10) Object Code: 5481000
11) Vendor: St. Vincent’s House
12) Vendor Contract No:
Expenditure Budget/Revenue Projections
13) Fund Name: General Funds
14) Fund #: 1101
15) Current Year Budgeted: 160,000
16) Current Year Projected: 30,000
17) Year 2:
18) Year 3:
19) Year 4:
20) Year 5:
21) Totals: 30,000
To Be Completed by Purchasing Department
22) Contract Start Date: 10/15/2024
23) Auto Renewal Contract: No
24) Bid No: 24-009
25) Contract End Date: 10/14/2025
26) Contract # Issued by Purchasing Department: CM24318
NOTES:
FY25 INITIAL FINANCIAL ASSISTANCE AWARD