Contract Approval Request Form
To Be Completed by Requesting Department (#1-21)
1) Date of Request: 3/25/2025
2) Contract Type: Expense
3) Renewal Contract: Yes
4) Department Name: Facilities
5) Department Contact: Veronica Van Horn
6) Description: Change Order No. 3 for Galveston County Mental Health Wellness Center satellite catering area to kitchen
7) PEID No: 721935
8) Req No:
9) Orgkey: 2901-411010
10) Object Code: 5781000
11) Vendor: Construction LTD
12) Vendor Contract No: CM24129
Expenditure Budget/Revenue Projections
13) Fund Name: ARPA
14) Fund #: 1101
15) Current Year Budgeted:
16) Current Year Projected: $284,500.92
17) Year 2:
18) Year 3:
19) Year 4:
20) Year 5:
21) Totals:
To Be Completed by Purchasing Department
22) Contract Start Date: 12/23/2024
23) Auto Renewal Contract: No
24) Bid No: 24-026
25) Contract End Date: 12/22/2025
26) Contract # Issued by Purchasing Department: Bonfire# 207802 / SC-0000791
NOTES: