Contract Approval Request Form
To Be Completed by Requesting Department (#1-22)
1) Date of Request: 10/26/2026
2) Contract Type: Expense
3) Renewal Contract: Yes
4) Department Name: County Clerk - Elections Division
5) Department Contact: Wendi Fragoso
6) Description: License and Support - Poll Pads
7) Fund Name and Number: 2103 Election Services and Contract Fund
8) Cost Center: 114031 Election Services
9) Ledger Account Summary: 5423000: Maintenance and Repairs - Service Equipment
10) Spend Category: Repair and Maintenance for Equipment - Services
11) Project Worktag (when applicable):
12) Grant Worktag (when applicable):
13) Vendor: HART intercivic
14) Vendor Contract Number: ☒ Yes ☐ No: Click or tap here to enter text.
Expenditure Budget/Revenue Projections
15) Budget Amendment Requested: ☐ Yes ☒ No (if yes, provide BA request details): Click or tap here to enter text.
16) Current Year Budgeted: $35,219.00
17) Current Year Projected: $35,219.00
18) Year 2:
19) Year 3:
20) Year 4:
21) Year 5:
22) Totals:
To Be Completed by Purchasing Department
23) Contract Start Date: 10/1/2026
24) Auto Renewal Contract: Choose an item.
25) Bid No:
26) Contract End Date: 9/30/2027
27) Contract # Issued by Purchasing Department: SC-0000686
NOTES: