Contract Approval Request Form
To Be Completed by Requesting Department (#1-22)
1) Date of Request: 6/9/2026
2) Contract Type: Revenue
3) Renewal Contract: Yes
4) Department Name: Test
5) Department Contact: Tester
6) Description (language as it will appear on agenda): Consideration of approval of test item number 3 submitted by the County Judge
7) Fund Name and Number: 456789
8) Cost Center: 11111
9) Ledger Account Summary: 22222
10) Spend Category: 33333
11) Project Worktag (when applicable): 44444
12) Grant Worktag (when applicable): 55555
13) Vendor: Tester
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): Click or tap here to enter text.
16) Current Year Budgeted:
17) Current Year Projected:
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: