Contract Approval Request Form
To Be Completed by Requesting Department (#1-21)
1) Date of Request: 10/1/2024
2) Contract Type: Expense
3) Renewal Contract: Yes
4) Department Name: Tax Office
5) Department Contact: Cheryl E. Johnson
6) Description: Annual Canon DR-G2090 Scanner Maintenance Agreement 3767
7) PEID No: 722590
8) Req No: N/A
9) Orgkey: 2107 151552
10) Object Code: 5419301
11) Vendor: DBE - Data Business Equipment
12) Vendor Contract No: 3767
Expenditure Budget/Revenue Projections
13) Fund Name: Software Licensing & Maintenance
14) Fund #: 5419301
15) Current Year Budgeted: $1,662.00
16) Current Year Projected: $1,662.00
17) Year 2:
18) Year 3:
19) Year 4:
20) Year 5:
21) Totals: $1,662.00
To Be Completed by Purchasing Department
22) Contract Start Date 11/01/2024
23) Auto Renewal Contract: No
24) Bid No: NA
25) Contract End Date: 10/31/2025
26) Contract # Issued by Purchasing Department: CM24015
NOTES: