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: No
4) Department Name: Facilities
5) Department Contact: Veronica Van Horn
6) Description: Infrared inspections on critical equipment
7) PEID No: BIDCON
8) Req No:
9) Orgkey: 1101 170100
10) Object Code: 5481000
11) Vendor: Zurich
12) Vendor Contract No:
Expenditure Budget/Revenue Projections
13) Fund Name: General
14) Fund #: 1101
15) Current Year Budgeted: $1,380.00
16) Current Year Projected: $1,031,000.00
17) Year 2:
18) Year 3:
19) Year 4:
20) Year 5:
21) Totals:
To Be Completed by Purchasing Department
22) Contract Start Date: 10/28/2024
23) Auto Renewal Contract: No
24) Bid No: NA
25) Contract End Date: 10/27/2025
26) Contract # Issued by Purchasing Department: CM25024
NOTES:
Service required to comply with GIA subjectivity clause to retain flat rate and no increase. - HB1295 to be requested.