Okaloosa County BOCC — September 16, 2014 — Contract Closeout Checklist-EMS Billing

09-08-14P12:03 RCVD CONTRACT CLOSE-OUT CHECKLIST (To Be Prepared by the Purchasing Services Coordinator) DATE: 09/08/2014 TO: Contracts & Grants Manager, Finance Department Contracts & Grants Office SUBJECT: Contract No. C99-0257-PS MANAGING DEPARTMENT: Public Safety CONTRACTOR'S NAME: lntermedix/Advanced Data Processing, Inc. PROJECT TITLE: Ambulance Billing The attached has met the final payment contract requirement in subject contract. Yes No l. Final Invoice ~ D 2. Completed Contract/Lease Payment Approval Form ~ D 3. Close-Out Documents Yes No N/A a. Signed Release of Lien D D ~ b. Proof of Completion Advertisement D D ~ c. Certificate of Insurance D D ~ d. Consent of Surety to Final Payment D D ~ e. Proof of Performance/Payment Bond D D ~ Continuation 12 Months Following Final Payment Yes No 4. Agenda Request ~ D· 5. Remarks ¥-tu9Nf I DATE v