Contract Approval Request Form
To Be Completed by Requesting Department (#1-21)
1) Date of Request: 12/3/2024
2) Contract Type: Expense
3) Renewal Contract: No
4) Department Name: Facilities
5) Department Contact: Veronica Van Horn
6) Description: Furniture for Mental Health Wellness Center
7) PEID No: 723145
8) Req No:
9) Orgkey: 1101-412110
10) Object Code: 5744000
11) Vendor: McCoy-Rockford
12) Vendor Contract No:
Expenditure Budget/Revenue Projections
13) Fund Name: General
14) Fund #: 1101
15) Current Year Budgeted:
16) Current Year Projected: $504,014.45
17) Year 2:
18) Year 3:
19) Year 4:
20) Year 5:
21) Totals:
To Be Completed by Purchasing Department
22) Contract Start Date: TBA
23) Auto Renewal Contract: No
24) Bid No: NA
25) Contract End Date: TBA
26) Contract # Issued by Purchasing Department: CM25061
NOTES:
Purchasing Cooperative requested vendor packet - HB1295 to be requested