Contract Approval Request Form
To Be Completed by Requesting Department (#1-21)
1) Date of Request: 11/28/2023
2) Contract Type: Other
3) Renewal Contract: No
4) Department Name: Facilities
5) Department Contact: Mark A. Garcia
6) Description: For construction materials testing -Phase 2 -Road&Bridge Project
7) PEID No: 718487
8) Req No:
9) Orgkey: 3210312115
10) Object Code: 5781000
11) Vendor: Alpha Testing , LLC
12) Vendor Contract No:
Expenditure Budget/Revenue Projections
13) Fund Name: 3210
14) Fund #:
15) Current Year Budgeted: $49,129
16) Current Year Projected:
17) Year 2:
18) Year 3:
19) Year 4:
20) Year 5:
21) Totals:
To Be Completed by Purchasing Department
22) Contract Start Date: TBD
23) Auto Renewal Contract: No
24) Bid No: NA
25) Contract End Date: TBD
26) Contract # Issued by Purchasing Department: CM24106
NOTES: HB1295 to be requested - Contract Start date contingent on project start day