Contract Approval Request Form
To Be Completed by Requesting Department (#1-21)
1) Date of Request: 5/14/2025
2) Contract Type: Expense
3) Renewal Contract: No
4) Department Name: Professional Services
5) Department Contact: Diana Huallpa
6) Description: Amendment to the agreement between the County of Galveston and the Galveston County United Board of Health
7) PEID No: PENDING
8) Req No:
9) Orgkey: 1101-411010, 411071, 411043
10) Object Code: 5481000
11) Vendor: Galveston County United Board of Health
12) Vendor Contract No:
Expenditure Budget/Revenue Projections
13) Fund Name: General Fund
14) Fund #: 1101
15) Current Year Budgeted: 7,033,422
16) Current Year Projected: 7,033,422
17) Year 2:
18) Year 3:
19) Year 4:
20) Year 5:
21) Totals: 7,033,422
To Be Completed by Purchasing Department
22) Contract Start Date: 5/23/2025
23) Auto Renewal Contract: No
24) Bid No: N/A
25) Contract End Date: 5/22/2026
26) Contract # Issued by Purchasing Department: 222812
NOTES: