Contract Approval Request Form
To Be Completed by Requesting Department (#1-22)
1) Date of Request: 9/28/2026
2) Contract Type: Expense
3) Renewal Contract: Yes
4) Department Name: Professional Services
5) Department Contact: Diana Huallpa
6) Description (language as it will appear on agenda): To provide additional financial assistance
7) Fund Name and Number: 1101 General Fund
8) Cost Center: 440100
9) Ledger Account Summary: 5481000
10) Spend Category: Other Contract Services
11) Project Worktag (when applicable):
12) Grant Worktag (when applicable):
13) Vendor: M.I. Lewis Social Service Center
14) Vendor Contract Number: ☒ Yes ☐ No: SC-0000697
Expenditure Budget/Revenue Projections
15) Budget Amendment Requested: ☐ Yes ☒ No (if yes, provide BA request details): Click or tap here to enter text.
16) Current Year Budgeted: $170,000
17) Current Year Projected: $170,000
18) Year 2:
19) Year 3:
20) Year 4:
21) Year 5:
22) Totals: $170,000
To Be Completed by Purchasing Department
23) Contract Start Date: 10/1/2024
24) Auto Renewal Contract: No
25) Bid No: 24-009
26) Contract End Date: 9/30/2027
27) Contract # Issued by Purchasing Department: SC-0000697
NOTES: Awarded in CC - Item 100 (9/16/24 MF) Executed in CC - Item 52 (10/28/24 MF) $30,000.00 fund release approved in CC - Item 43 (11/25/24 MF)
1st extension approved in CC - Item 29 (8/4/25 MF)
Amendment for additional funds approved in CC - Item 58 (3/16/26 MF)