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Okaloosa County BOCC — October 4, 2013 — Contract Payment Form — reading text
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CONTRACT/LEASE
PAYMENT APPROVAL FORM
COMPLETE AND FORWARD TO THE NEXT DEPARTMENT
COMPLETED BY DEPARTMENT
DATE: 10/29/2013
VENDOR NAME: GAT-AIRLINES GROUND SUPPORT VENDOR #: 20600472
CONTRACT/LEASE#: C-06-1299-AP
TASK COUNTY/FEMA
VENDOR BUDGET
ORDER # PROJECT # ACCOUNT # AMOUNT $
INVOICE # Uf Applicable) Of Applicable) DEPARTMENT #
21966 4202 534422 $ 5,751.66
TOTAL | $ 5,751.66
APPROVED FOR PROGRESS PAYMENT (please sign, as applicable and date)
CONTRACTOR'S ENGINEER/ARCHITECT/PROJECT MANAGER: DATE:
COUNTY SUPERVISOR/PROJECT MANA Me DFO
. : TRACY STAGE
DEPARTMENT DIRECTOR:
G SUNIL ween
CONTRACTS & GRANT wanacn, / Z. LLA De < od) Jan
. ' ~~)
COUNTY ADMINISTRATOR:
(Payments>$25,000.)
DATE: /6: 30. i 2
DATE: of fo] t3
DATE: -\ | | is lis
DATE:
FINAL PAYMENT
FINAL PAYMENT YES xX NO (if "Yes", forward to Purchasing Services Coordinator for Close-Out)
DATE: PURCHASING DIRECTOR:
(Per Initial Agreement)
DATE: \\ A344 CONTRACTS & GRANTS MANAGER: ALA Loe. Korot.
(All Contracts) . ~ —
DATE: nly ah COUNTY ADMINISTRATOR APPROVAL; 5,751.2 LY,
: (Per Initial Agreement) . G
DATE: BOARD APPROVAL:
(Per Initial Agreement)
COMPLETED BY FINANCE - ACCOUNTS PAYABLE ONLY
FISCAL YEAR:
DATE RECEIVED:
REVIEWED BY: