Okaloosa County BOCC — August 4, 2015 — TLT Lease Renewal

CONTRACT/LEASE RENEWAL FORM May 18, 2015 TLT Transport, LLC Attn: Dominic Persichini 3061 Chippewa Lane Pace, FL 32571 RE: Contract Renewal #C07-1474-PS Dear Mr. Persichini, The Okaloosa County Board of County Commissioners agrees to renew the subject contract/lease, # C07-1474-PS for an additional term. The contract renewal period will be 10/01/2015 to 09/30/2016 . The annual budgeted amount for this contract is $50,000.00 . All other terms and conditions of the original agreement shall remain in full force and effect through the duration of this renewal. If you are in agreement, please sign below and return this form along with a current Certificate of Insurance listing Okaloosa County as co-insured (if applicable). AUTHORIZED COMPANY REPRESENTATIVE Contractor: TLT Transport, LLC ¥ Q\\ //. Approved By:( <;7 T i, Glovia Pfl(btl chini Approved By: (as prescribe Date: Sl Approved By: Title: 00 -Owner (as prescribed below on item 1) Date: Date: h-30-15 County Department Instructions: 1) Obtain signatures from Department Director, authorized Company Representative and then 2) 3) Purchasing Director <$25K and less, County Administrator <$50K and less or Board >$50K, as necessary. If Board approval is required, the Chairman and County Administrator's signatures are required. Make sure the company provides a current Certificate of Insurance. (If applicable). Keep a copy of this form for your records. Send original to Purchasing Services Coordinator. If you have any questions please contact the Purchasing Director at 850-689-5960, Fax: 850- 689-5998. CONTRACT & LEASE INTERNAL COORDINATION SHEET Contract/Lease Number:_ C O 7~ )4 7%-F S Tracking Number: [55’)5 - _ Grant Funded: YES NO Contractor/Lessee Name: TL,/ //1»0.4«4.4791} - 7 Purpose /1/9% gw\n«,g,@flg //f'ws\«,&r PW Date/Term: C?/ 33/ | & 1. [] GREATER THAN $50,000 Amount: O 09 i 2. [] GREATER THAN $25,000 Department: ps 3. D $25,000 OR LESS Dept. Monitor Name: \//%’M-‘ /@}(A/ézfi\—f Document has been reviewed and includes any attachments or exhibits. Purchasing Review /// Date: é ~/ 7/15 Purchascfifi)l}e(or or Dés‘gnee Joanne Kublik or Sunnie Estes Risk Management Review Date: 7/ 4’ / \S‘~ Risk Manager or ignee Laura Porter or Krystal King — County Attorney Review pproved as wntten:\ " A ‘IG'L.L\‘K&«L\ Date: L’ ) (\{ M’-t) ( Cov@y ALLt(\)B'ne\) Gregory T. Stewart or Lynn Hoshihara Following Okaloosa County approval: Contracts & Grants Document has been received: . Date: Contracts & Grants Manager