Contract Approval Request Form
To Be Completed by Requesting Department (#1-21)
1) Date of Request: 4/2/2026
2) Contract Type: Expense
3) Renewal Contract: No
4) Department Name: Human Resources
5) Department Contact: Rebecca Gilliam
6) Description: Contract for Random Drug Screening
7) PEID No: 720157
8) Req No:
9) Orgkey: 1101 155000
10) Object Code: 5412101
11) Vendor: WellNow
12) Vendor Contract No:
Expenditure Budget/Revenue Projections
13) Fund Name: Contract Medical Services
14) Fund #: 1101
15) Current Year Budgeted:
16) Current Year Projected: $23,000.00
17) Year 2:
18) Year 3:
19) Year 4:
20) Year 5:
21) Totals:
To Be Completed by Purchasing Department
22) Contract Start Date: 4/1/2026
23) Auto Renewal Contract: No
24) Bid No: N/A
25) Contract End Date: 3/31/2027
26) Contract # Issued by Purchasing Department: 253584 (SC-0001039)
NOTES: HB1295 Requested