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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
pats; 10/10/2013
VENDOR.NAME; SECURUS
VENDOR #: 21001711
CONTRACT/LEASE#:
C10-1805-COR
VENDOR
INVOICE #
TASK
ORDER #
(If Applicable)
COUNTY/FEMA
PROJECT #
(ff Applicable)
BUDGET
DEPARTMENT #
ACCOUNT #
AMOUNT $
120988
1024
552401
$ 4,040.00
TOTAL
$ 4,040.00
APPROVED FOR PROGRESS PAYMENT (lease sign, as applicable and date)
CONTRACTOR'S ENGINEER/ARCHITECT/PROJECT MANAGER:
DEPARTMENT DIRECTOR:
CONTRACTS & GRANT MANAGER: ( "cr | "a ole
COUNTY ADMINISTRATOR:
(Payments>$23,000.)
DATE:
DATE:
DATE: /o. Ae is
DATE: \\ Nala
DATE:
Ir
|
FINAL PAYMENT YES
FINAL PAYMENT
Z AiuHe Yes", forward to Purchasing Services Coordinator for Close-Out)
DATE: PURCHASING DIRECTOR:
(Per Initial Agreement)
DATE: \(\is\li3 CONTRACTS & GRANT'S MANAGER: ax
* (All Contracts) . —)
DATE: // /, /3 Wy), 3S COUNTY ADMINISTRATOR APPROVAL;
. (Per Initial Agreement)
DATE: BOARD APPROVAL:
(Per Initial Agreement)
COMPLETED BY FINANCE - ACCOUNTS PAYABLE ONLY
FISCAL YEAR:
DATE RECEIVED:
REVIEWD BY: