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: Professional Services
5) Department Contact: Veronica Van Horn
6) Description: Renewal of annual policy premiums for Commercial Property, Flood & Windstorm Insurance
7) PEID No: 719491
8) Req No:
9) Orgkey: 6130 151431
10) Object Code: 5491725
11) Vendor: GIA Insurance
12) Vendor Contract No:
Expenditure Budget/Revenue Projections
13) Fund Name:
14) Fund #:
15) Current Year Budgeted: $2,650,000.00
16) Current Year Projected: $2,578,076.59
17) Year 2:
18) Year 3:
19) Year 4:
20) Year 5:
21) Totals:
To Be Completed by Purchasing Department
22) Contract Start Date: 11/1/2024
23) Auto Renewal Contract: No
24) Bid No: B222021
25) Contract End Date: 10/31/2025
26) Contract # Issued by Purchasing Department: CM21601
NOTES:
Renewals for 11-01-2024 to 11-01-2025