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Okaloosa County BOCC — September 2, 2014 — Task order approval form C12-2007-TDC - 151 — reading text
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position(s) with your business.
your business), or “no”.
YES NO
NAME(S) POSITION(S)
_ . . Haat,
FIRM NAME: The Group Trade Leade- Ae. ( The Grove TAotet Loader
BY (PRINTED): Ke Lil SPriace é tet eee ce) er
BY (SIGNATURE): lle, “Taal a
TITLE: birelscee of Sales + Hank os £
DATE: F/ 3 My
ADDRESS: 30) Eact Hi cl Ct.
Lexing ton) ; Ky Hoso7
PHONE NO, &&E- AS3- 0YSE™
E-MAIL Ke) ly (2 Group tau) «| [eader. Cop
SINGLE SOURCE PURCHASE DATA SHEET
Date: 98/01/2014 PR No.: Requestor: Peter Mayer Phone No.: 504.581.7191
Department/Division: _Tourist Development Department (TDD)
litem Description: 2014/2015 Media Plan TO#XX
Requesting Department's Suggested Vendor: Small Market Meetings
Vendor's Address: 301 East High Street, Lexington, KY, 40507
Vendor's Telephone No.: 888-253-0455 Point of Contact: Kelly Tyner
Sole Source Justification: America's only magazine dedicated to smaller group meeting destinations
outside the country's largest cities.
\ KR SE oso1neia ° feXr f LY
Requesting D eee Head Signature Date
REVIEW BY PURCHASING DEPARTMENT
VERIFY IF OTHER SOURCES OF SUPPLY MEETS THIS NEED
Vendor #1 Coniact: Phone No.:
Vendor #2 Contact: Phone No.:
Vendor #3 Contact: Phone No.:
Buyer Comments:
Signature of Buyer Who Reviewed Date
Purchasing Services Manager Comments:
Purchasing Services Manager Signature Date
- PURCHASING MANUAL - SINGLE SOURCE DETERMINATION
Comments:
Approve: p= Disapprove:
Amount of Purchase: Date:
Bf 22 [14
Purchasing Director Signature Bate /
Revised — 11/09/98, 03/21/00, 09/18/01, 03/19/02, 09/07/04, 05/15/07, 09/04/07, 09/03/08, 09/12/2011
19
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 alsa associated with
your business), or “no”. If yes, give person(s} name(s} and position(s) with your business.
Le ~
YES NO
NAME(S} POSITION(S)
FIRM NAME: Piodeer Pu& Lishsne (mu aca 2c Ssaral] Har ax Meakin
a
BY (PRINTED): ety lve
BY {SIGNATURE}: ly Ton _—— .
TITLE: Direl sco’ of Cale + Na Wicxing )
DATE: eis Ln
ADDRESS: 30; Eaot Hick (+.
Lixin ctos _ KY Yoso7
PHONE NO. fbb -— 35 —S/2€&
E-MAIL | ally (? Gcouptrase leader. bo