Contract Approval Request Form
To Be Completed by Requesting Department (#1-21)
1) Date of Request: 9/30/2025
2) Contract Type: Expense
3) Renewal Contract: Yes
4) Department Name: Emergency Management
5) Department Contact: Veronica Van Horn
6) Description: Fire Protection Services-VFD
7) PEID No: 716126
8) Req No:
9) Orgkey: 1101-291010
10) Object Code: 5452500
11) Vendor: Tiki Island VFD
12) Vendor Contract No:
Expenditure Budget/Revenue Projections
13) Fund Name: General
14) Fund #: 1101
15) Current Year Budgeted:
16) Current Year Projected: $22,500.00
17) Year 2:
18) Year 3:
19) Year 4:
20) Year 5:
21) Totals:
To Be Completed by Purchasing Department
22) Contract Start Date: 10/1/2025
23) Auto Renewal Contract: No
24) Bid No: N/A
25) Contract End Date: 9/30/2026
26) Contract # Issued by Purchasing Department: 237731
NOTES: