Contract Approval Request Form
To Be Completed by Requesting Department (#1-21)
1) Date of Request: 4/30/2025
2) Contract Type: Expense
3) Renewal Contract: No
4) Department Name: County Clerk Treasury
5) Department Contact: Annaya Nigrelle
6) Description: Handheld credit card machine for Bolivar
7) PEID No: Pending
8) Req No:
9) Orgkey: 114000
10) Object Code: 5423000
11) Vendor: Govolution, LLC
12) Vendor Contract No:
Expenditure Budget/Revenue Projections
13) Fund Name: County Clerk
14) Fund #: 114000
15) Current Year Budgeted: $2000.00
16) Current Year Projected:
17) Year 2:
18) Year 3:
19) Year 4:
20) Year 5:
21) Totals:
To Be Completed by Purchasing Department
22) Contract Start Date: 5/12/2025
23) Auto Renewal Contract: Yes
24) Bid No: N/A
25) Contract End Date: 5/11/2026
26) Contract # Issued by Purchasing Department: 214216
NOTES: