Contract Approval Request Form
To Be Completed by Requesting Department (#1-21)
1) Date of Request: 11/21/2025
2) Contract Type: Expense
3) Renewal Contract: Yes
4) Department Name: Professional Services
5) Department Contact: Diana Huallpa
6) Description: Physician Assistant Contract - CPS case related exams & associated services
7)
8) PEID No: 402812
9) Req No:
10) Orgkey: 1206443300
11) Object Code: 5412133
12) Vendor: UTMB
13) Vendor Contract No:
Expenditure Budget/Revenue Projections
14) Fund Name: Child Welfare Fund
15) Fund #: 1206
16) Current Year Budgeted: 190,000
17) Current Year Projected: 190,000
18) Year 2:
19) Year 3:
20) Year 4:
21) Year 5:
22) Totals:
To Be Completed by Purchasing Department
23) Contract Start Date: 10/1/2025
24) Auto Renewal Contract: No
25) Bid No: N/A
26) Contract End Date: 9/30/2026
27) Contract # Issued by Purchasing Department: 242549
NOTES: HB1295 Requested