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Okaloosa County BOCC — December 31, 2012 — Meridian Final Invoice and Contract Payment Approval — reading text
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EXHIBIT I
CONTRACT/LEASE
PAYMENT APPROVAL FORM
COMPLETE AND FORWARD TO THE NEXT APPROVING DEPARTMENT
COMPLETED BY DEPARTMENT
DATE: 11/19/2012
VENDOR NAME: Meridian VENDOR #: N36
COUNTY AGREEMENT # (Contact Contract/Lease Coordinator, if unknown) C11-1864-GM
TASK COUNTY/FEMA
VENDOR ORDER # PROJECT # BUDGET
INVOICE # (if applicable) (if applicable) EPARTMENT# ACCOUNT # AMOUNT
3 701140 563490 $42,370.94
TOTAL $42,370.94
APPROVED FOR PAYMENT (please initial, as applicable and date):
ENGINEER/ARCHITECT/PROJECT MANAGER DATE:
COUNTY PROJECT MANAGER: On DATE: _ \\.\A-la
; N)
—_
DEPARTMENT HEAD: CK [A DATE: _ufacfene -
FINAL PAYMENT: — YES NO [J]
CONTRACTS & GRANTS
HE a at g $B
DATE: [| 79-\2- CONTRACTS & GRANTS MANAGER: _//; 2
DATE: COUNTY ADMINISTRATOR APPROVAL : (Only Payments $25,001 - $50,000)
FINAL PAYMENT APPROVAL (if needed):
PURCHASING DIRECTOR: (Only Contracts < = $25,000)
COUNTY ADMINISTRATOR : (Only Contracts between $25,001 to $50,000)
Contracts Over $50,000 — BCC Approved
COMPLETED BY FINANCE - ACCOUNTS PAYABLE ONLY
FISCAL YR:
DATE RECEIVED:
Form revised 1-20-2011
Meridian Community Services Group, Inc.
1500 Mahan Drive, Suite 250
Tallahassee. FL 32308 _ Date |
ERIDIA : :
“Invoice #-
856-877-1908 £0/23/2012
. PK
%
Bil To
‘OkaloosaCo. CDBG SSS
- Atta: Abra McGill, Grant Specialist
/ 600 Transu Way
Fort Walton Beach, FL 32547
| erent Activity. -
¢ Close Gat Final Amount
Jay Moseley Hours
Date Hours Tasks
16/1/2012 3 Reporting - Davis Bacon Reviews
10/3/2012 1. MBE Report
16/4/2012 4.5 MBE Report
16/8/2012 ? Davis Bacon Reviews
16/8/2012 4 Davis Bacon Reviews
10/16/2042 2 Davis Bacon Reviews
10/25/2012 2 Davis Bacon Reviews
10/19/2042 2 Davis Bacon Reviews
10/16/2012 3 Davis Bacon Reviews
40/48/2022 4 Davis Bacon Reviews
10/49/2012 6 Close Out Report
10/25/2642 3 Davis Bacon Reviews
Total Hours: 38.5