Contract Approval Request Form
To Be Completed by Requesting Department (#1-22)
1) Date of Request: 6/9/2026
2) Contract Type: Other
3) Renewal Contract: No
4) Department Name: Test
5) Department Contact: TEST
6) Description (language as it will appear on agenda): Consideration of approval of test item number 2 submitted by the County Judge
7) Fund Name and Number: 98765
8) Cost Center: 222222
9) Ledger Account Summary: 333333
10) Spend Category: 444444
11) Project Worktag (when applicable): 000000
12) Grant Worktag (when applicable):00000
13) Vendor: Test
14) Vendor Contract Number: ☐ Yes ☒ No: Click or tap here to enter text.
Expenditure Budget/Revenue Projections
15) Budget Amendment Requested: ☒ Yes ☐ No (if yes, provide BA request details): Testing
16) Current Year Budgeted: 0
17) Current Year Projected: 0
18) Year 2:
19) Year 3:
20) Year 4:
21) Year 5:
22) Totals:
To Be Completed by Purchasing Department
23) Contract Start Date: Click or tap to enter a date.
24) Auto Renewal Contract: Choose an item.
25) Bid No:
26) Contract End Date: Click or tap to enter a date.
27) Contract # Issued by Purchasing Department:
NOTES: