Okaloosa County BOCC — September 16, 2014 — reading text

Shalimar, 32579 Okaloosa County-Crestview Industrial Park Water Well Dale Brazel 10244 5759 John Givens Road Okaloosa Chlorine 850-978-0020 Crestview, 32536 24 08/10/2014 Packet Pg. 327  ATTACHMENT C - OKALOOSA COUNTY SECTION 302 FACILITY LIST 2014-2015 Okaloosa County-Fire Pump Facility/Bob Sikes Airport Dale Brazel 33210 5759 John Givens Road Okaloosa Chlorine 850-978-0020 Crestview, 32536 Okaloosa County-Forest Avenue Water Well Dale Brazel 25813 Forest Avenue and Eldrideg Road Okaloosa Chlorine 850-978-0020 Fort Walton Beach, 32547 Okaloosa County-Green Acres Water Well Dale Brazel 10239 Green Acres Road Okaloosa Chlorine 850-978-0020 Fort Walton Beach, 32547 Okaloosa County-Green Street Water Well Dale Brazel 10237 Green Street and Clifford Street Okaloosa Chlorine 850-978-0020 Fort Walton Beach, 32547 Okaloosa County-Hawkins Water Well Dale Brazel 10240 Hawkins Road Okaloosa Chlorine 850-978-0020 Fort Walton Beach, 32547 Okaloosa County-Kennedy Lakes Water Well Dale Brazel 30393 97 West Navajo Trace Okaloosa Chlorine 850-978-0020 Crestview, 32536 Okaloosa County-Live Oak Water Well Dale Brazel 10245 Live Oak Road Okaloosa Chlorine 850-978-0020 Crestview, 32536 Okaloosa County-Longwood Water Well Dale Brazel 10236 Sunset Lane and Sharilyn Drive Okaloosa Chlorine 850-978-0020 Shalimar, 32579 Okaloosa County-Lowery Water Well Dale Brazel 20758 Lowery Drive and Commanche Avenue Okaloosa Chlorine 850-978-0020 Fort Walton Beach, 32547 Okaloosa County-Newcastle Water Well Dale Brazel 10238 Newcastle Drive and Ross Road Okaloosa 850-978-0020 Fort Walton Beach, 32547 Okaloosa County-North Beal Extension Site Dale Brazel 15331 1564 Percy L Coleman Road Okaloosa Chlorine 850-978-0020 Fort Walton Beach, 32548 25 08/10/2014 Packet Pg. 328  ATTACHMENT C - OKALOOSA COUNTY SECTION 302 FACILITY LIST 2014-2015 Okaloosa County-Northgate Water Well Dale Brazel 10241 Jonquil Avenue Okaloosa Chlorine 850-978-0020 Fort Walton Beach, 32547 Okaloosa County-Oddfellow Water Tank Dale Brazel 34026 Oddfellow Road Okaloosa Chlorine 850-978-0020 Fort Walton Beach, 32547 Okaloosa County-Office Water Well Dale Brazel 10235 First Avenue and Eglin Street Okaloosa Chlorine 850-978-0020 Fort Walton Beach, 32547 Okaloosa County-Okaloosa Island Booster Station Dale Brazel 30392 110 West Amberjack Drive Okaloosa Chlorine 850-978-0020 Fort Walton Beach, 32547 Okaloosa County-Russell Stephenson WWTP Darren Alford 10249 3182 West US Highway 98 Okaloosa Chlorine 850-651-7179 Mary Esther, 32569 Okaloosa County-Shalimar Water Well Dale Brazel 10234 Seventh Street Okaloosa Chlorine 850-978-0020 Shalimar, 32579 26 08/10/2014 Packet Pg. 329  Attachment D FINANCIAL INVOICE FORM FOR HAZARDOUS MATERIALS HAZARDS ANALYSIS UPDATE _________________________________________________________________ RECIPIENT: Okaloosa County AGREEMENT# 15-CP-11-01-56-XXX FEID#: 59-6000765 DUNS#:__________ AMOUNT AMOUNT APPROVED REQUESTED BY THE BY THE RECIPIENT DIVISION 1. First Payment (45% of contract amount) $ $ (50% Hazards Analyses completed/submitted) 2. Second Payment (45% of contract amount) $ $ (50% Hazards Analyses completed/submitted) 3. Final Payment (10% of contract amount) $ $ (Approval, distribution & notification) TOTAL AMOUNT $ $ (To be completed by the Division) I certify that to the best of my knowledge and belief the billed costs are in accordance with the terms of the Agreement. ______________________________________________ _________ Signature of Authorized Official/Title Date TOTAL AMOUNT TO BE PAID AS OF THIS INVOICE $ (To be completed by the Division) 27 Packet Pg. 330  Attachment E JUSTIFICATION OF ADVANCE PAYMENT RECIPIENT: If you are requesting an advance, indicate same by checking the box below. [ ] ADVANCE REQUESTED Advance payment of $ _____________ is requested. Balance of payments will be made on a reimbursement basis. These funds are needed to pay staff, award benefits to clients, duplicate forms and purchase start-up supplies and equipment. We would not be able to operate the program without this advance. If you are requesting an advance, complete the following chart and line item justification below. ESTIMATED EXPENSES BUDGET CATEGORY/LINE ITEMS 20___-20___ Anticipated Expenditures for First Three Months of (list applicable line items) Contract For example ADMINISTRATIVE COSTS (Include Secondary Administration.) For example PROGRAM EXPENSES TOTAL EXPENSES LINE ITEM JUSTIFICATION (For each line item, provide a detailed justification explaining the need for the cash advance. The justification must include supporting documentation that clearly shows the advance will be expended within the first ninety (90) days of the contract term. Support documentation should include quotes for purchases, delivery timelines, salary and expense projections, etc. to provide the Division reasonable and necessary support that the advance will be expended within the first ninety (90) days of the contract term. Any advance funds not expended within the first ninety (90) days of the contract term shall be returned to the Division Cashier, 2555 Shumard Oak Boulevard, Tallahassee, Florida 32399, within thirty (30) days of receipt, along with any interest earned on the advance) ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________