Okaloosa County BOCC — September 16, 2014 — APAC-Form

AO | CONTRACT/LEASE RENEWAL FORM Date: August 18, 2014 08-27-14P12:44 RCVD Apac Mid-South, Inc. Attn: Tunstall Perry 4375 Mecoy Drive Pensacola, FL 32503 RE: Asphalt Materials Contract Dear Tunstall: The Okaloosa County Board of County Commissioners, agrees to renew the subject contract/lease, #C14-2082 PW for an additional term. The contract renewal period will be 9/30/14 to 9/30/15. The annual budgeted amount for this contract is $ 250,000. 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). COUNTY REPRESENTATIVES AUTHORIZED COMPANY REPRESENTATIVE Contractor: MIDSOUTH PAVING, ING Ve Approved a, SK. - Approved bya é —— - ERNIE PADGETT Tunstall B. Perry IV Approved By: Title: Vice President CHARLES K. WINDES, JR, CHAIRMAN Date: Date S*E7 -EDS. County Department Instructions: 1) Obtain signatures from Department Director, authorized Company Representative and then Purchasing Director <$25K and less, County Administrator <S50K 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). 2) Keep a copy of this form for your records. 3) Send original to Purchasing Services Coordinator. If you have any questions please contact the Purchasing Director at 850-689-5960, Fax: 850- 689-5998.