Contract Approval Request Form
To Be Completed by Requesting Department (#1-21)
1) Date of Request: 12/27/2023
2) Contract Type: Expense
3) Renewal Contract: Yes
4) Department Name: Information Technology
5) Department Contact: Misty Witmer
6) Description: Multi-domain SSL certificate for CISCO RMA with Shi Govt Solutions submitted by Information Technology
7) PEID No: 703308
8) Req. No: FR403493
9) Org key: 1101-159100
10) Object Code: 5419301
11) Vendor: SHI GOVT Solutions
12) Vendor Contract No: SR-23793 Quote Number - 24307603
Expenditure Budget/Revenue Projections
13) Fund Name: General Fund
14) Fund #: 1101
15) Current Year Budgeted: $3500.00
16) Current Year Projected: $1088.40
17) Year 2:
18) Year 3:
19) Year 4:
20) Year 5:
21) Totals:
To Be Completed by Purchasing Department
22) Contract Start Date: 2/9/2024
23) Auto Renewal Contract: No
24) Bid No: NA
25) Contract End Date: 2/8/2025
26) Contract # Issued by Purchasing Department: CM24123
NOTES: HB1295 requested