Contract Approval Request Form
To Be Completed by Requesting Department (#1-21)
1) Date of Request: 12/23/2024
2) Contract Type: Expense
3) Renewal Contract: Yes
4) Department Name: Information Technology
5) Department Contact: Misty Witmer
6) Description: Consideration of approval of Field Training Online annual subscription with CentralSquare Technologies submitted by Information Technology
7) PEID No: 720912
8) Req No: FR503033
9) Orgkey: 1101159100
10) Object Code: 5419310
11) Vendor: CentralSquare Technologies
12) Vendor Contract No:
Expenditure Budget/Revenue Projections
13) Fund Name: General
14) Fund #: 1101
15) Current Year Budgeted: $5,500.00
16) Current Year Projected: $5,457.38
17) Year 2:
18) Year 3:
19) Year 4:
20) Year 5:
21) Totals:
To Be Completed by Purchasing Department
22) Contract Start Date: 1/12/2025
23) Auto Renewal Contract: No
24) Bid No: NA
25) Contract End Date: 1/11/2026
26) Contract # Issued by Purchasing Department: CM23452
NOTES: HB1295 on file