Contract Approval Request Form
To Be Completed by Requesting Department (#1-21)
1) Date of Request: 2/5/2024
2) Contract Type: Expense
3) Renewal Contract: No
4) Department Name: Juvenile Justice Department
5) Department Contact: Glen Watson
6) Description: New Fire Alarm System
7) PEID No: 700250
8) Req No: FR404369
9) Orgkey: 1202-256105
10) Object Code: 5722000
11) Vendor: Siemens Industry Inc.
12) Vendor Contract No: Sourcewell 030421
Expenditure Budget/Revenue Projections
13) Fund Name: Juvenile Justice Fund
14) Fund #: 1202
15) Current Year Budgeted: $102,699.00
16) Current Year Projected: $102,699.00
17) Year 2:
18) Year 3:
19) Year 4:
20) Year 5:
21) Totals: $102,699.00
To Be Completed by Purchasing Department
22) Contract Start Date: 2/12/2024
23) Auto Renewal Contract: No
24) Bid No: NA
25) Contract End Date: 2/13/2025
26) Contract # Issued by Purchasing Department: CM24146
NOTES: - HB1295 Requested - SourceWell # 030421
Working with the Budget Office to finalize a Budget Amendment.