Contract Approval Request Form
To Be Completed by Requesting Department (#1-21)
1) Date of Request: 10/22/2024
2) Contract Type: Expense
3) Renewal Contract: Yes
4) Department Name: Emergency Management
5) Department Contact: Veronica Van Horn
6) Description: Fire Protection Services
7) PEID No: 033209
8) Req No:
9) Orgkey: 1101-291010
10) Object Code: 5452500
11) Vendor: City of LaMarque
12) Vendor Contract No:
Expenditure Budget/Revenue Projections
13) Fund Name: General
14) Fund #: 1101
15) Current Year Budgeted:
16) Current Year Projected: $22,500.00
17) Year 2:
18) Year 3:
19) Year 4:
20) Year 5:
21) Totals:
To Be Completed by Purchasing Department
22) Contract Start Date: 9/1/2024
23) Auto Renewal Contract: Yes
24) Bid No: NA
25) Contract End Date: 8/31/2025
26) Contract # Issued by Purchasing Department: CM25023
NOTES:
Expires 09/30/2028