Contract Approval Request Form
To Be Completed by Requesting Department (#1-22)
1) Date of Request: 7/8/2026
2) Contract Type: Expense
3) Renewal Contract: No
4) Department Name: Mosquito Control District
5) Department Contact: Haley Billiot
Description: Consideration of resultant contract from ITB 26-094, Permethrin 31% & 66% Piperonyl Butoxide with Azelis US Holdings, Inc. dba ADAPCO, LLC submitted by the Mosquito Control Department
6) Fund Name and Number: Mosquito Control District 2410
7) Cost Center: 411100
8) Ledger Account Summary: Cleaning yard and chemical supplies
9) Spend Category: Insecticides and Chemicals
10) Project Worktag (when applicable):
11) Grant Worktag (when applicable):
12) Vendor: Azelis US Holdings, Inc. dba ADAPCO, LLC
13) Vendor Contract Number: ☐ Yes ☒ No:
Expenditure Budget/Revenue Projections
14) Budget Amendment Requested: ☐ Yes ☒ No (if yes, provide BA request details):
15) Current Year Budgeted: $650,000
16) Current Year Projected: $51,000
17) Year 2:
18) Year 3:
19) Year 4:
20) Year 5:
21) Totals:
To Be Completed by Purchasing Department
22) Contract Start Date: 7/21/2026
23) Auto Renewal Contract: No
24) Bid No: 26-094
25) Contract End Date: 7/20/2029
26) Contract # Issued by Purchasing Department: SC-0001096
NOTES: