Contract Approval Request Form
To Be Completed by Requesting Department (#1-21)
1) Date of Request: 6/12/2025
2) Contract Type: Expense
3) Renewal Contract: No
4) Department Name: County Clerk
5) Department Contact: Jason Nguyen
6) Description: Marriage Records x Index Books - Digital Images
7) PEID No: 722345
8) Req No: REQ-0003455
9) Orgkey: 114021
10) Object Code: 5700000
11) Vendor: Fidlar
12) Vendor Contract No:
Expenditure Budget/Revenue Projections
13) Fund Name: Archive
14) Fund #: 1201
15) Current Year Budgeted: 100,000
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: 6/23/2025
23) Auto Renewal Contract: No
24) Bid No: N/A
25) Contract End Date: 6/22/2025
26) Contract # Issued by Purchasing Department: 226520
NOTES: HB1295 to be requested