Contract Approval Request Form
To Be Completed by Requesting Department (#1-21)
1) Date of Request: 12/27/2024
2) Contract Type: Expense
3) Renewal Contract: Yes
4) Department Name: Information Technology
5) Department Contact: Misty Witmer
6) Description: Consideration of approval of OnBase annual maintenance renewal with Databank IMX LLC submitted by Information Technology
7) PEID No: 708970
8) Req No: N/A
9) Orgkey: 1101159100
10) Object Code: 5419301
11) Vendor: Databank IMX LLC
12) Vendor Contract No:
Expenditure Budget/Revenue Projections
13) Fund Name: General
14) Fund #: 1101
15) Current Year Budgeted: $193,100.00
16) Current Year Projected: $193,052.70
17) Year 2:
18) Year 3:
19) Year 4:
20) Year 5:
21) Totals:
To Be Completed by Purchasing Department
22) Contract Start Date: Click or tap to enter a date.
23) Auto Renewal Contract: Choose an item.
24) Bid No:
25) Contract End Date: Click or tap to enter a date.
26) Contract # Issued by Purchasing Department:
NOTES: