Contract Approval Request Form
To Be Completed by Requesting Department (#1-21)
1) Date of Request: 10/3/2024
2) Contract Type: Expense
3) Renewal Contract: Yes
4) Department Name: Sheriff’s Office
5) Department Contact: Kevin Walker
6) Description: Inmate Healthcare
7) PEID No: 721661
8) Req No:
9) Orgkey: 1101211133
10) Object Code: 5412095
11) Vendor: VitalCore
12) Vendor Contract No:
Expenditure Budget/Revenue Projections
13) Fund Name: General
14) Fund #: 1101
15) Current Year Budgeted: $7 Million
16) Current Year Projected: $7,799,113.27
17) Year 2:
18) Year 3:
19) Year 4:
20) Year 5:
21) Totals:
To Be Completed by Purchasing Department
22) Contract Start Date: 10/1/2020
23) Auto Renewal Contract: No
24) Bid No: B202004
25) Contract End Date: 9/30/2024
26) Contract # Issued by Purchasing Department: CM20170
NOTES: HB1295 on file