Contract Approval Request Form
To Be Completed by Requesting Department (#1-21)
1) Date of Request: 12/2/2024
2) Contract Type: Expense
3) Renewal Contract: Yes
4) Department Name: Contract Services
5) Department Contact: Veronica Van Horn
6) Description: First amendment to Medical Examiner increase in threshold from $900,000 to $1,000,000
7) PEID No: 402812
8) Req No:
9) Orgkey: 1101-440100
10) Object Code: 5412130
11) Vendor: UTMB
12) Vendor Contract No:
Expenditure Budget/Revenue Projections
13) Fund Name: General Fund
14) Fund #: 1101
15) Current Year Budgeted: $905,000.00
16) Current Year Projected: $1,000,000
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: No
24) Bid No: NA
25) Contract End Date: 8/31/2025
26) Contract # Issued by Purchasing Department: CM23479
NOTES:
A budget amendment requested for $100,000.00 for FY25