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Okaloosa County BOCC — September 3, 2013 — payment approval form — reading text
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CONTRACT/LEASE
PAYMENT APPROVAL FORM
COMPLETE AND FORWARD TO THE NEXT DEPARTMENT
COMPLETED BY DEPARTMENT
DATE: 10/18/2013
VENDOR NAME: Gulf Coast Traffic Engineers, Inc. VENDOR #:; 000519
CONTRACT/LEASE#: C13-2050-PW (Airport Rd. Safety Improvements)
TASK COUNTY/FEMA
VENDOR BUDGET
INVOICE # ORDER # PROJECT# — | peparTmeNT#| ACCOUNT# AMOUNT $
(If Applicable) Cf Applicable)
96597 NA 4105 302 2051100 $ 7,290.98
TOTAL $ 7,290.98
APPROVED FOR PROGRESS PAYMENT (please sign, as applicable and date)
CONTRACTOR'S ENGINEER/ARCHITECT/PROJECT MANAGER: As ~— DATE: / O/ 23/ / ‘3
J i KOOME
COUNTY SUPERVISOR/PROJECT ges SHITE EL: ; Le Sg ® ac DATE: fp 2F AF
DEPARTMENT DIRECTOR: CH DATE: QAF/KS
CONTRACTS & GRANT MANAGER: DATE:
COUNTY ADMINISTRATOR: DATE:
(Paymenis>$25,000.)
FINAL PAYMENT
FINAL PAYMENT vesl¥ lvol_| (If "Yes", forward to Purchasing Services Coordinator for Close-Out)
DATE: PURCHASING DIRECTOR:
(Per Initial Agreement)
DATE: (O-aA-\ SS CONTRACTS & GRANTS MANAGER: erates Ke oun.
—_
(All Contracts)
DATE: le /3 L Sf, V4 COUNTY ADMINISTRATOR APPROVAL;
f
(Per Initial Agreement)
DATE: BOARD APPROVAL: <<.
COMPLETED BY FINANCE - ACCOUNTS PAYABLE ONLY
FISCAL YEAR:
DATE RECEIVED:
REVIEWD BY:
(Per Initial Agreement) \ .