CONTRACT ACTION SUMMARY FORM CONTRACT NUMBER: Contract Information: State Entity Date Supplier Name Supplier ID Contract Number Date Contract Title NIGP Code(s) Open Statewide Contract Type: Contact Information: State Entity Supplier Contract Administrator Contact Name Street Street City State: City State Zip Zip Phone Phone Email Email Business Small Business Yes No Georgia Small Yes No Owner Resident Phone Georgia Yes No Georgia Yes No Resident Manufactured Email Performance Period: Initial Term: Effective Date: Expiration Date: Renewal Options (if any): through Exercised 1st Renewal? Renewal Period: Yes No through Exercised 2nd Renewal? Renewal Period: Yes No through Exercised 3rd Renewal? Renewal Period: Yes No through Exercised 4th Renewal? Renewal Period: Yes No CONTRACT NAME: NUMBER: Department of Revenue Bonds (if any): Tax Compliance Initial Value Renewal Period: Initial Clearance
CONTRACT ACTION SUMMARY FORM CONTRACT NUMBER: Contract Information: State Entity Date Supplier Name Supplier ID Contract Number Date Contract Title NIGP Code(s) Contract Type: Open Statewide Contact Information: State Entity Supplier Contract Administrator Contact Name Street Street City State: City State Zip Zip Phone Phone Email Email Business Owner Small Business Yes No Georgia Small Resident Yes No Phone Georgia Resident Yes No Georgia Manufactured Yes No Email Performance Period: Initial Term: Effective Date: Expiration Date: Renewal Options (if any): Exercised 1st Renewal? Yes No Renewal Period: through Exercised 2nd Renewal? Yes No Renewal Period: through Exercised 3rd Renewal? Yes No Renewal Period: through Exercised 4th Renewal? Yes No Renewal Period: through CONTRACT NAME: NUMBER: Bonds (if any): Department of Revenue Tax Compliance Initial Value Renewal Period: Initial Clearance
SPD-CP007ContractActionSummaryForm.docx