Contract Approval Request Form
To Be Completed by Requesting Department (#1-21)
1) Date of Request: 10/02/2024
2) Contract Type: Expense
3) Renewal Contract: Yes
4) Department Name: Tax Office
5) Department Contact: Cheryl E. Johnson
6) Description: Annual Check Scanners Maintenance Agreement 2480
7) PEID No: 722590
8) Req No: N/A
9) Orgkey: 1101 151500
10) Object Code: 5423000
11) Vendor: DBE - Data Business Equipment
12) Vendor Contract No: 2480
Expenditure Budget/Revenue Projections
13) Fund Name: Maintenance & Repair Equipment
14) Fund #: 5423000
15) Current Year Budgeted: $884.00
16) Current Year Projected: $884.00
17) Year 2:
18) Year 3:
19) Year 4:
20) Year 5:
21) Totals: $884.00
To Be Completed by Purchasing Department
22) Contract Start Date: 11/1/2024
23) Auto Renewal Contract: Yes
24) Bid No: NA
25) Contract End Date: 10/31/2025
26) Contract # Issued by Purchasing Department: CM24032
NOTES: