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Okaloosa County BOCC — November 5, 2013 — Contract Lease payment Approval Form Atkins — reading text
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CONTRACT/LEASE
PAYMENT APPROVAL FORM
COMPLETE AND FORWARD TO THE NEXT DEPARTMENT
COMPLETED BY DEPARTMENT
DATE: 11/26/2013
VENDOR NAME: ATKINS VENDOR #: 012182
CONTRACT/LEASE#: (C08-1684-AP VPS-SWPPP and SPCC Plan Update
TASK COUNTY/FEMA
VENDOR BUDGET
INVOICE # ORDER # PROJECT # DEPARTMENT #| ACCOUNT # AMOUNTS
(If Applicable) (If Applicable)
1181363 2 4202 531100 3,766.46
TOTAL | $ 3,766.46
APPROVED FOR PROGRESS PAYMENT (please sign, as applicable and date)
CONTRACTOR'S ENGINEER/ARCHITECT/PROJECT MANAGER: DATE:
COUNTY SUPERVISOR/PROJECT MANAGE: ff Ky 4, — DATE: /2° 2-7/3
. i] Tracy Stage, A.A.E.
DEPARTMENT DIRECTOR: DATEZ2 ZH
Wi ‘/ Sunil Harman, A.A.E., IAP
DE CONTRACTS & GRANT MANAGE DATE:
COUNTY ADMINISTRATOR: DATE:
(Payments> $25,000.)
FINAL PAYMENT
FINAL PAYMENT YES x NO__ (if "Yes", forward to Purchasing Services Coordinator for Close-Out)
DATE: PURCHASING DIRECTOR:
(Per Initial Agreement)
DATE: (D-\OAR CONTRACTS & GRANTS MANAGER: [S rarer (lan ‘S nr
(All Contracts)
DATE: COUNTY ADMINISTRATOR ApPROVBES wean defen fof! Ie
(Per Initial Agreement)
DATE: BOARD APPROVAL:
(Per Initial Agreement)
COMPLETED BY FINANCE - ACCOUNTS PAYABLE ONLY
FISCAL YEAR:
DATE RECEIVED:
REVIEWED BY: