Contract Approval Request Form
To Be Completed by Requesting Department (#1-21)
1) Date of Request: 11/21/2025
2) Contract Type: Expense
3) Renewal Contract: Yes
4) Department Name: Contract Services
5) Department Contact: Veronica Van Horn
6) Description: Interlocal with UTMB for Medical Examiner Services
7) PEID No: 402812
8) Req No:
9) Orgkey: 1101-440100
10) Object Code:
11) Vendor: UTMB
12) Vendor Contract No:
Expenditure Budget/Revenue Projections
13) Fund Name: 1101
14) Fund #: General
15) Current Year Budgeted:
16) Current Year Projected: $1,151,000.00
17) Year 2:
18) Year 3:
19) Year 4:
20) Year 5:
21) Totals:
To Be Completed by Purchasing Department
22) Contract Start Date: 9/1/2025
23) Auto Renewal Contract: No
24) Bid No: N/A
25) Contract End Date: 8/31/2027
26) Contract # Issued by Purchasing Department: 242550 (SC-0000996)
NOTES: