Contract Approval Request Form
To Be Completed by Requesting Department (#1-21)
1) Date of Request: 6/30/2025
2) Contract Type: Expense
3) Renewal Contract: No
4) Department Name: Contract Services
5) Department Contact: Dianna Huallpa or Veronica Van Horn
6) Description: Interlocal Agreement for Financial Auditing and Consulting Services with Galveston County Health District
7) PEID No: 431945
8) Req No:
9) Orgkey: 1101-440100
10) Object Code: 5481000
11) Vendor: Galveston County Health District
12) Vendor Contract No:
Expenditure Budget/Revenue Projections
13) Fund Name: General
14) Fund #: 1101
15) Current Year Budgeted:
16) Current Year Projected: $175,000.00
17) Year 2:
18) Year 3:
19) Year 4:
20) Year 5:
21) Totals:
To Be Completed by Purchasing Department
22) Contract Start Date: 7/7/2025
23) Auto Renewal Contract: No
24) Bid No: N/A
25) Contract End Date: 7/7/2026
26) Contract # Issued by Purchasing Department: 227848
NOTES: HB1295 not required