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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: 10/03/13
VENDOR NAME: Sandman, LLC VENDOR #: 20500470
CONTRACT/LEASE #: C08-1562-TDC
VENDOR TASK COUNTY/FEMA BUDGET ACCOUNT # | AMOUNT $
INVOICE# ORDER # PROJECT # DEPARTMENT #
(If Applicable) (If Applicable)
2751 1170 534109 $27,364.00
Destin September-2013 TOTAL $27,364.00
APPROVED FOR PROGRESS PAYMENT (Please sign as applicable and date)
DATE:
aR DATE: “OY Ra 2
CONTRACTOR'S ENGINEER/ARCHITECT/PROJECT MANAGER:
COUNTY SUPERVISOR/PROJECT MAN.
DEPARTMENT DIRECTOR: onus F CH PAU AVN DATE: /0/'7
i” — _"
CONTRACTS & GRANTS MANAGER: A DATE:
COUNTY ADMINISTRATOR: DATE:
Payments>$25,000.)
FINAL PAYMENT
FINAL PAYMENT WX no 9K. (If "Yes", forward to Purchasing Services Coordinator for Close-Out)
DATE: PURCHASING DIRECTOR
(Per Initial Agreement)
AE DATE: [o-2Q3 — CONTRACTS & GRANTS MANAGER wy, oe a
(All Contracts) .
DATE: ,@/3 HY 3 COUNTY ADMINISTATOR APPROVAL Vim cate
f f 8
(Per Initial Agreement)
DATE: BOARD APPROVAL
(Per Initial Agreement)
COMPLETED BY FINANCE - ACCOUNTS PAYABLE ONLY Seu Nsss
FISCAL YEAR:
DATE RECEIVED:
REVIEWED BY: