Contract Approval Request Form
To Be Completed by Requesting Department (#1-21)
1) Date of Request: 4/13/2026
2) Contract Type: Expense
3) Renewal Contract: No
4) Department Name: Road & Bridge
5) Department Contact: Zach Smith
6) Description: Micro Surface Treatment for Jeffrey St in Dickinson, TX, utilizing TIPS Contract #250503
7) PEID No:
8) Req No: 2301
9) Orgkey: 312120
10) Object Code: Repair & Maintenance Road & Bridges- Services
11) Vendor: Intermountain Slurry Seal
12) Vendor Contract No: TIPS # 250503
Expenditure Budget/Revenue Projections
13) Fund Name: FM Lateral Roads
14) Fund #: 2301
15) Current Year Budgeted: 1,510,000.00
16) Current Year Projected: 45,489.50
17) Year 2:
18) Year 3:
19) Year 4:
20) Year 5:
21) Totals:
To Be Completed by Purchasing Department
22) Contract Start Date: 4/27/2026
23) Auto Renewal Contract: No
24) Bid No: N/A
25) Contract End Date: 4/26/2027
26) Contract # Issued by Purchasing Department: 254285 (SC-0001042)
NOTES: