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2. Approval for Contracts Under $20,000 Form

   Directions: 
   This form is to be used to ensure a complete review by the Department of Law, Purchasing and County Administrator for contracts under $20,000 prior to execution by the Chairman. The signed agreement with all exhibits, certificate of insurance and any other backup documentation must be included with the submission of this form.

   Reminder: 
   All software agreements should be reviewed and approved by the IT Department prior to submission for Board of Supervisors/County Administrator approval.

   Per the Purchasing Policy, all contracts binding the county must be added into the Enterprise ERP contract module. Upon receipt of the final executed contract, the Board of Supervisors Office will input the contract into Enterprise ERP.

4. Department Information
6. Requesting Department*
   -- Select One --Assigned Counsel (AC)Board of Elections (BOE)Board of Supervisors (BOS)Communications/E911 (COM)County Administrator (ADM)County Attorney Office (CAT)County Clerk's Office (CCO)District Attorney (DAT)Emergency Management (EMG)Facilities (FAC)Finance (FIN)Highway (HWY)Information Technology (IT)Mental Health (MH)Personnel & Civil Service (PCS)Planning (PLA)Purchasing (PUR)Probation (PRO)Public Health (DOH)Real Property (RP)Sheriff's Office (SHR)Social Services (DSS)Solid Waste (SW)Treasurer (TRE)Veterans Service Agency (VET)Youth Bureau (YB)
7. Which Committee do you report to?*
   -- Select One --Government Operations Finance, Ways and MeansAdministration and OversightHealth and Human ServicesPlanning, Economic Development, Environmental and Intergovernmental AffairsPublic Utility Service (MCPLUS)Criminal Justice, Public Safety and Emergency CommunicationsHighway, Buildings and GroundsSolid Waste and Recycling
9. Submission Date*
   Submission Date
11. Your Name *
13. Contract / Vendor Information
15. Contract Number*

    As assigned by the Department (i.e. 22-ABC-1). If you have questions, please contact the County Attorney's Office (x2203).

17. Vendor Name*
19. Contract Amount*
21. Additional Contract Amount Details
23. If the contract amount is over $5,000, has Laurie Winters, Purchasing Agent, been consulted?*

    1. Yes
    2. No
    3. N/A

    If no, please contact her immediately.

25. Contract Type*
    -- Select One --ProfessionalGoods & Services under $5,000Goods & Services $5,000 or overSoftwareOther
27. If Contract Type is Other, describe here:
29. Good & Services Contracts over $5,000, provide evidence of three quotes obtained:
31. If this is for Software, was the contract reviewed and approved by Paul Lutwak, IT Director?*

    1. Yes
    2. No
    3. N/A

    If no, please contact him immediately.

33. Scope of Services Description:*
35. Contract Term*
    Contract Term Start Date

    —

    Contract Term End Date
37. Is this an extension or modification of a previously approved contract?*

    1. Yes
    2. No
39. If YES, upload a copy of the original signed contract.
41. Renewal Option Included?*

    1. Yes
    2. No
43. Upload Signed Agreement*

    The agreement must include all supporting documents i.e. exhibits, certificate of insurance, any other back up documentation

45. Additional Documents

    Attach anything else relevant to the approval of this contract.

46. Additional Document

    Attach anything else relevant to the approval of this contract.
    
    

47. Additional Document

    Attach anything else relevant to the approval of this contract.

Leave This Blank:


49. 1. Receive an email copy of this form.
50. Email address

    This field is not part of the form submission.

51. Submit Submit and Print

* indicates a required field