Contract Approval Request Form
To Be Completed by Requesting Department (#1-21)
1) Date of Request: 11/19/2024
2) Contract Type: Other
3) Renewal Contract: No
4) Department Name: Information Technology
5) Department Contact: Misty Witmer
6) Description: Consideration of approval of Securitas No Cost Change Order to add dual card reader with Securitas Technology submitted by Information Technology
7) PEID No: 710680
8) Req No: FR501761
9) Orgkey: 1101159100
10) Object Code: 5423000
11) Vendor: Securitas Technology
12) Vendor Contract No: SourceWell # 030421-SCD
Expenditure Budget/Revenue Projections
13) Fund Name: General
14) Fund #: 1101
15) Current Year Budgeted: $54,835.12
16) Current Year Projected: $0.00
17) Year 2:
18) Year 3:
19) Year 4:
20) Year 5:
21) Totals:
To Be Completed by Purchasing Department
22) Contract Start Date: 8/19/2024
23) Auto Renewal Contract: No
24) Bid No: NA
25) Contract End Date: 8/18/2025
26) Contract # Issued by Purchasing Department: CM24259
NOTES:
Zero cost change order - HB1295 is not required-publicly traded company