READ ALONGSIDE THE SOURCE
Okaloosa County BOCC — September 3, 2013 — payment approval form — reading text
Part 1 of 1. These parts divide the reading text for browsing; they are not the source document's page numbers.
Machine-extracted text — 97-payment approval form.pdf
Machine-extracted OCR text · Review label: Machine produced / unreviewed
Compare this copy with the preserved source. Review labels describe the recorded status of this file; they do not guarantee that the text is error-free. Spacing and line breaks are retained, with long lines wrapped to fit the screen.
CONTRACT/LEASE
PAYMENT APPROVAL FORM
COMPLETE AND FORWARD TO THE NEXT DEPARTMENT
COMPLETED BY DEPARTMENT
DATE: 10/22/13
VENDOR NAME: ‘Technology Integration Group VENDOR #:
CONTRACT/LEASE #; C04-1023-ISé
VENDOR TASK COUNTY/FEMA BUDGET ACCOUNT # AMOUNT $
INVOICE # ORDER # PROJECT # DEPARTMENT #
(If Applicable) (If Applicable)
395609 019 01115 531500 $2.278.00
10/11/13 0114 541010 $3.182.50
TOTAL $5.460.50
APPROVED FOR PROGRESS PAYMENT (please sign, as applicable and date
CONTRACTOR’S ENGINEER/ARCHITECT/PROJECT
COUNTY SUPERVISOR TROIEGES AGER: W 1c Ko Lendaly i ET tase velo [an Lo l aaa [: ZpiLS
DEPARTMENT DIRECTOR: Ce [e~ ([4~ctrTLe. (ee alhaele DATE: __/ 6/22 | Hot }| 2
CONTRACTS & GRANTS MANAGER: DATE:
COUNTY ADMINISTRATOR: DATE:
(Payments > $25,000.)
FINAL PAYMENT
FINAL PAYMENT YES |x | NO | | Cf “Yes”, forward to Purchasing Services Coordinator for Close-Out)
DATE: PURCHASING DIRECTOR:
(Per Initial Agreement)
DATE: \ On-2BA~AB CONTRACTS & GRANTS MANAGER: W wrdln Ve aWun
(All Contracts) the
DATE: _/@/ E/ yz COUNTY ADMINISTRATOR APPROVAL: <2 4,2..0 eee Le
(Per Initial Agreement)
DATE: BOARD APPROVAL:
(Per Initial Agreement)
COMPLETED BY FINANCE - ACCOUNTS PAYABLE ONLY
FISCAL YEAR:
DATE RECEIVED:
REVIEWED BY: