Contract Approval Request Form
To Be Completed by Requesting Department (#1-21)
1) Date of Request: 2/12/2024
2) Contract Type: Expense
3) Renewal Contract: No
4) Department Name: Human Resources
5) Department Contact: Rebecca Gilliam
6) Description: Consideration of approval for Texas Association of Counties (TAC) to produce the 2024 1095C forms, as required by the Affordable Care Act
7) PEID No: 721726
8) Req No:
9) Orgkey: 1101 110000
10) Object Code: 5481000
11) Vendor: Texas Association of Counties (TAC)
12) Vendor Contract No:
Expenditure Budget/Revenue Projections
13) Fund Name: Other Contract Services
14) Fund #: 1101 110000 5481000
15) Current Year Budgeted: 1,425,500
16) Current Year Projected: 1,425,500
17) Year 2:
18) Year 3:
19) Year 4:
20) Year 5:
21) Totals:
To Be Completed by Purchasing Department
22) Contract Start Date: 2/19/2024
23) Auto Renewal Contract: No
24) Bid No: NA
25) Contract End Date: 2/18/2025
26) Contract # Issued by Purchasing Department: CM24148
NOTES: HB1295 is not required