Okaloosa County BOCC — March 18, 2014 — 2013-03-18 ParksByNature Order Form — reading text

PARKSBYNATURE NETWORK, LLC Proud Partner Sponsorship Order www.parksbynature.com NATURE: NETWORK Order # 00 Date: 3 / é [ly ParksByNature Rep: James Melillo, ParksByNature 1431 Broadway, Fl. #12, New York, NY 10018 #631-291-2610 Beth Melillo, ParksByNature 1431 Broadway, FI. #12, New York, NY 10018 #646-480-3546 x- 115 Fax # 212- 695-5744 (An caida E£ me rx Coad cA t: CAarle te Dunevor VA contect, EC de Ar cere ae Fane FSD) O9~ SITS Address: JIS YY) ¢ Vee. e Sr O foxy? pens ¢ CC j EF Ox [hon en Frad< 3 SVE Phone: xSO- “609 ~S 2FO j os JIS Email: QTc Ais ae FEC, oka looSa “URL for Digital banner to link to your website: cx: OS O-6S/S~ WYP ww, CMC ald coast] com wt Media Banner Ad to appear on: Official State Parks ro Ranger® mobile App (State: FA ) STATIC ____ FULL ROTATION*** RI REGION FULL en hand ec 4 county \ Details: V acrvin, See oes ST Qa. dy “Raaeches /_ PaRKis) Rok on os wher EL App a > -- <= — f CATEGORY G9) Mektiere2 Ex POSUNG of Casal uA Additional State on Pocket Ranger® Mobile App** AL VY Boyz ne Ar Q fA KERIB F&W Pocket Ranger app ~< excl0S-ve ALL Sttectkte Gotchos Splesn Page {+00 ANDRIOD/APPLE MOBILE APP fh MOBILE WEBSITE Promotional Posters “Official Proud Partner” Count cs Personalized Promotional Posters for your own business Count *** Initials: i fj UY 12 MONTH TERM TOTAL “Proud Partner Program” (NET) Fee $ | LOD Payment Terms: ____ Total Amount $ Deposit Paid $ Balance due $ _____ Paid in Full (Check # ) _™ Make payable to ParksByNature Network, LLC Payment Terms (Approved) \Y_Need Invoice from PBN office for processing Additional Payment mail to: Beth Melillo, ParksByNature Network, 1431 Broadway 12" floor NY NY 10018 # 646-480-3546 x- 115 Fax #212 695-5744 bethm@parkbynature.com We will follow up with creative specs once payment received. Please feel free to call with any questions. SPONSORSHIP TERMS: By completing, executing this Order Form, you agree to the terms of the Sponsorship Program including its creative specifications, payment schedules and Terms and Conditions Sponsorships are not considered secured until ParksByNature Network has received full payment and countersigned this agreement. PARKSBYNATURE NETWORK, LLC Company: oak Jol Z. LY Lf? LL» Signature: Print Name James MelillS Print Name. Print Title: Corporate Ambassador Print Title: Date: 3/4 Lid Date: SOLE SOURCE PURCHASE DATA SHEET Date: _3/10/14 PR No.: Requestor: Phone No.: Department/Division: Tourist Development Item Description: Pocket Ranger app advertising Requesting Department's Suggested Vendor: ParksByNature Network LLC Vendor's Address: 1431 Broadway, Fir 12, New York, NY 10018 Vendor's Telephone No.: 631-291-2610 Point of Contact: James Melillo Sole Source Justification: Exclusive partner of Florida Park Service to provide free smartphone app. EZ Hal shih Requesting Department Director Signature Date REVIEW BY PURCHASING DEPARTMENT VERIFY IF OTHER SOURCES OF SUPPLY MEETS THIS NEED Vendor #1 Contact: Phone No.: Vendor #2 Contact: Phone No.: Vendor #3 Contact: Phone No.: Buyer Comments: Signature of Buyer Who Reviewed Date Purchasing Services Coordinator Comments: Purchasing Services Coordinator Signature Date PURCHASING MANUAL - SOLE SOURCE DETERMINATION Comments: Approve: Disapprove: Amount of Purchase: Date: Purchasing Director Signature Date CONFLICT OF INTEREST DISCLOSURE FORM For purposes of determining any possible conflict of interest, all bidders/proposers, must disclose if any Okaloosa Board of County Commissioner, employee(s), elected officials(s), or if any of its agencies is also an owner, corporate officer, agency, employee, etc., of their business. Indicate either “yes” (a county employee, elected official, or agency is also associated with your business), or no”. If yes, give person(s) name(s) and position(s) with your business. YeS__ NO NAME(S) POSITION(S) FIRM NAME: Cr (KS BY Ma=fere BY (PRINTED): Hames le Va BY (SIGNATURE): USA AOR TITLE: or pore fe Awa DATE: | BS 6 Vii | JY2/ Broadway 72 my AY NY JOO F § PHONE NO. CRI 7AXI-X6C/O Aame Sle Parks Ly AQT - ADDRESS: COm E-MAIL