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Okaloosa County BOCC — September 16, 2014 — APAC-Form — reading text
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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.