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Okaloosa County BOCC — July 2, 2013 — Seago Final - Contract Payment Form — reading text
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CONTRACT/LEASE
PAYMENT APPROVAL FORM
COMPLETE AND FORWARD TO THE NEXT DEPARTMENT
5
COMPLETED BY DEPARTMENT
pate: 07/12/2013
VENDOR NAME: Sago Fire Protection VENDOR #:
CONTRACTILEASE#: ©13-2011-COR
TASK COUNTY/FEMA
VENDOR BUDGET
INVOICE # ORDER # PROJECT# =| nepARTMENT #| ACCOUNTS AMOUNTS
(If Applicable) (If Applicable)
1 Final Corrections Facility 3120 562231 $ 132,009.00
TOTAL $ 132,009.00
APPROVED FOR PROGRESS PAYMENT (please signgas applicable and date
CONTRACTOR'S ENGINEER/ARCHITECT/PROJECT MANAGER: PBaysp singe DATE: 9*/57 20/8
COUNTY SUPERVISOR/PROJE DATE:
p yo N
DEPARTMENT DIRECTOR: ‘3 ——=— we pate: 72/23 (0S
———S- v / . iY
CONTRACTS & GRANT MANAGER: Spo Kae pate: Tlawli3
~~
COUNTY ADMINISTRATOR: DATE:
(Payments » $25,000.)
FINAL PAYMENT
FINAL PAYMENT ved lol _| (if "Yes", forward to Purchasing Services Coordinator for Close-Out)
DATE: PURCHASING DIRECTOR:
(Per Initial Agreement)
DATE: CONTRACTS & GRANTS MANAGER:
(All Contracts)
DATE: COUNTY ADMINISTRATOR APPROVAL:
(Per Initial Agreement)
DATE: BOARD APPROVAL:
(Per Initial Agreement)
COMPLETED BY FINANCE - ACCOUNTS PAYABLE ONLY
FISCAL YEAR:
DATE RECEIVED:
REVIEWD BY: