Contract Approval Request Form
To Be Completed by Requesting Department (#1-21)
1) Date of Request: 10/16/2025
2) Contract Type: Expense
3) Renewal Contract: No
4) Department Name: Professional Services
5) Department Contact: Veronica Van Horn
6) Description: Funding allocation to the Gulf Coast Center for Mental Health Wellness Center-Opioid Abatement Settlement Account funds
7) PEID No: 400782
8) Req No:
9) Orgkey: opioid abatement settlement account funds
10) Object Code:
11) Vendor: Gulf Coast Center
12) Vendor Contract No:
Expenditure Budget/Revenue Projections
13) Fund Name:
14) Fund #:
15) Current Year Budgeted:
16) Current Year Projected: $300,000.00
17) Year 2:
18) Year 3:
19) Year 4:
20) Year 5:
21) Totals:
To Be Completed by Purchasing Department
22) Contract Start Date: 10/1/2025
23) Auto Renewal Contract: Yes
24) Bid No: N/A
25) Contract End Date: 9/30/2026
26) Contract # Issued by Purchasing Department: 238990 (SC-0000984)
NOTES: HB1295 Pending