Contract Request

This form is used for Formal bids over $50,000 and Informal Bids under $50,000
Formal bids over $50,000 must be placed out to bid for a minimum of 21 days
Informal bids under $50,000 must be placed out to bid for a minimum of 5 days
All services must be placed out to bid unless documentation is completed stating the reason it cannot be placed to bid

Fiscal - Contract Request Form

Choose one:

Contract Under $50,000

Contract Over $50,000

Modification to increase contract, or extension of time

Requestor Information

Your Full Name

Room Number

Phone Number

Division

Fiscal Information

Please enter your Grant Number OR General Fund DAX String below (Click here for the DAX Conversion Listing)

Order will not be processed without correct fiscal information.

Grant #

G50XXXX

Fund #

i.e. 2250, 2251, etc

Program

i.e. CW001, HE002, etc

Section 3

i.e. 500XXX

Section 4

i.e. HE09, HE27, etc

Contract Information

Brief description of services

Please provide a one sentence description of the contract.

Contract Amount

Contract Start Date

Contract End Date

Upload Detailed Scope of Services

Maximum file size: 10MB

If contract is exempt from bidding requirements, please explain: (example: Manifestly impractical to bid, sole source, training, membership, etc)

Will client information be assessed or shared with this vendor? (PHI/HIPAA)

Yes

Questions needed for legislation (contracts over $50,000)

Who and how many are being served/impacted?

How will they be served?

What is the contact info if someone wants to learn more about this?

Questions needed for legislation (contract modification)

Who and how many are being served/impacted?

How will they be served?

What is the contact info if someone wants to learn more about this?

Why the need for additional goods or services could not be foreseen at the time the contract was initially awarded?

Why it would not be in the city's best interests to have the additional contract requirements awarded through other procurement processes specified in this chapter?

How was the price for these additional goods or services determined?

Only complete Vendor Information if not going out to bid

Use "N/A" if not applicable.

Vendor Company Name

Vendor Contact Name

Vendor Tax ID or D365 ID

Vendor Email

Phone

Approvals

Please double check email address spelling for accuracy. Notifications will be sent to email addresses to request signatures.

Supervisor's Email

Full Typed Name - Supervisor

Date

Supervisor Signature

Clear

Division Administrator's Name

Division Administrator's Email

Full Typed Name - Division Administrator

Date

Division Administrator Signature

Clear

Fiscal Analyst's Name

Fiscal Analyst's Email

Full Typed Name - Fiscal Analyst

Date

Fiscal Analyst Signature

Clear

Notify Additional Viewers

Yes, I would like to notify someone of this request

Additional email recipients (view only)

Add email recipients (separate multiple addresses by comma)

If you are human, leave this field blank.