Contract Approval Request Form
To Be Completed by Requesting Department (#1-21)
1) Date of Request: 12/23/2024
2) Contract Type: Expense
3) Renewal Contract: No
4) Department Name: Purchasing
5) Department Contact: Rufus Crowder
6) Description: Payment Risk Solutions - Fraud Prevention Services - GIACT
7) PEID No: 722535
8) Req No:
9) Orgkey: 1101151800
10) Object Code: 5481000
11) Vendor: LSEGA, Inc. dba GIACT Systems, LLC
12) Vendor Contract No: CM19204
Expenditure Budget/Revenue Projections
13) Fund Name: Contract Services
14) Fund #: 1101
15) Current Year Budgeted: $10,500.00
16) Current Year Projected: $10,500.00
17) Year 2: $10,500.00
18) Year 3: $10,500.00
19) Year 4: $10,500.00
20) Year 5: $10,500.00
21) Totals: $10,500.00/yr
To Be Completed by Purchasing Department
22) Contract Start Date: 5/20/2019
23) Auto Renewal Contract: Yes
24) Bid No: NA
25) Contract End Date: 5/19/2025
26) Contract # Issued by Purchasing Department: CM19204
NOTES: