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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
_——— ere a = —— = ————SEe il
COMPLETED BY DEPARTMENT
DATE: 10/14/2013
VENDOR VULCAN MATERIALS VENDOR #: 15498
CONTRACT/LEASE#: (C05-1266-PW 4
VENDOR TASK COUNTY/FEMA BUDGET
ORDER # PROJECT # DEPARTMENT | ACCOUNT # AMOUNT $
INVOICE # ‘
(If Applicable) (If Applicable) Wh # /
30425495 3204 7 553010 3,700.93
302. ZOSj/000
Total 3,700.93
APPROVED FOR PROGRESS PAYMENT (please sign, as applicable and date)
CONTRACTOR'S ENGINEER/ARCHITECT/PROJECT MANAGER: DATE:
COUNTY SUPERVISOR/PROJECT MANAGER: hea Sh cemong DATE:
DEPARTMENT DIRECTOR: CO on f John Hofstad DATE: / ; y
CONTRACTS & GRANT wanna Wa DATE:
COUNTY ADMINISTRATOR: DATE:
(Payments> $25,000.)
I = — : = — j
ho FINAL PAYMENT
FINAL PAYMENT YES_/4 NO__ (if "Yes", forward to Purchasing Services Coordinator for Close-Out)
DATE: PURCHASING DIRECTOR:
(Per Initial Agreement)
pe DATE: i) —24Als CONTRACTS & GRANTS MANAGER: & ere bode
(All Contracts)
DATE: 10 /: 3/ i) VE COUNTY ADMINISTRATOR APPROVALS eee
(Per Initial Agreement)
DATE: BOARD APPROVAL:
(Per Initial Agreement)
COMPLETED BY FINANCE - ACCOUNTS PAYABLE ONLY
FISCAL YEAR:
DATE RECEIVED:
REVIEWD BY:
ZIO4E