Contract Approval Request Form
To Be Completed by Requesting Department (#1-22)
1) Date of Request: 10/26/2026
2) Contract Type: Expense
3) Renewal Contract: Yes
4) Department Name: Galveston County Clerk’s Office - Elections Divison
5) Department Contact: Wendi Fragoso
6) Description: Annual License and Support - Verity
7) Fund Name and Number: 2103 Election Services Contract Fund
8) Cost Center: 114031 Election Services
9) Ledger Account Summary: 5423000: Maintenance and Repairs - Service Equipment
10) Spend Category: Repair and Maintenance for Equipment - Services
11) Project Worktag (when applicable):
12) Grant Worktag (when applicable):
13) Vendor: HART intercivic
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: $250,343.00
17) Current Year Projected: $250,343.00
18) Year 2:
19) Year 3:
20) Year 4:
21) Year 5:
22) Totals:
To Be Completed by Purchasing Department
23) Contract Start Date: 10/1/2026
24) Auto Renewal Contract: No
25) Bid No: N/A
26) Contract End Date: 9/30/2027
27) Contract # Issued by Purchasing Department: SC-0000687
NOTES: Includes retrofit of equipment needed to meet requirements for SB598
Approved CC 5/2/2022 - Item 43 (TW)