Okaloosa County BOCC — September 20, 2016 — CenturyLinkC08-1675-IS FinalPayment

CONTRACT/LEASE PAYMENT APPROVAL FORM COMPLETE AND FORWARD TO THE NEXT DEPARTMENT [ 11| COMPLETED BY DEPARTMENT DATE: 09/07/16 VENDOR NAME: CenturyLink VENDOR #: 015765 CONTRACT/LEASE #: C08-1675-1S VENDOR TASK COUNTY/FEMA BUDGET ACCOUNT # AMOUNT $ INVOICE # ORDER # PROJECT # DEPARTMENT # (If Applicable) (If Applicable) 311202851 01114 541010 $2.144.00 09/01/16 TOTAL $2.144.00 APPROVED FOR PROGRESS PAYMENT (please sign. as applicable and date CONTRACTOR'’S ENGINEER/ARCHITECT/PROJECT MANAGER: DATE: COUNTY SUPERVISOR/PROJECT MANAGKR: _ , P DATE: C DEPARTMENT DIRECTOR:‘-gq_ /\"J._ i M DATE: 8 é’ CONTRACTS & GRANTS MANAGER: DATE: COUNTY ADMINISTRATOR: DATE: (Payments > $25,000.) I 1]} FINAL PAYMENT FINAL PAYMENT YES NO l:] (If “Yes”, forward to Purchasing Services Coordinator for Close-Out) DATE: 4 ’ (3 ’ L PURCHASING DIRECTOR: 2 Jud \j*fi(m . B (Per Initial Agreement) ; > DATE: E - E —/ ;é CONTRACTS & GRANTS MANA! 2 (ALY (All Contracts) DATE: /é COUNTY ADMINISTRATOR APPROVAL: (Per Initial Agreement) / / DATE: BOARD APPROVAL: (Per Initial Agreement) IL . | COMPLETED BY FINANCE - ACCOUNTS PAYABLE ONLY FISCAL YEAR: DATE RECEIVED: REVIEWED BY: CONTRACT CLOSE-OUT CHECKLIST (To Be Prepared by the Purchasing Services Coordinator) DATE: September 13, 20146 TO: Contracts & Grants Manager, Finance Department Contracts & Grants Office SUBJECT: Contract No. C08-1675-1S MANAGING DEPARTMENT: IS CONTRACTOR'S NAME: CENTURY LINK PROJECT TITLE: TELEPHONE SERVICES The attached has met the final payment contract requirement in subject contract. Yes No 1. Final Invoice X 2, Completed Contract/Lease Payment Approval Form O X 3. Close-Out Documents Yes No N/A a. Signed Release of Lien [l ] X b. Proof of Completion Advertisement ] [] X c. Certificate of Insurance | Ll X d. Consent of Surety to Final Payment ] ] X e. Proof of Performance/Payment Bond ] O X Continuation 12 Months Following Final Payment Yes No 4, Agenda Request X b Remarks )13)16 ing Services Coordinator / "DATE Account Name: OKALOOSA COUNTY FINANCE DEPT Account Number: 311202851 P.O. Box 1319 Page: 1 of 8 Charlotte, NC 28201-1319 Bill Date: Sep. 01, 2016 Previo Pa Ad _IMPORTANT NEWS = . _ 4,288.00 2,144.00 CR 0.00 2,144.00 Payment Summary Previous Balance 4,288.00 Payment by check received on AUG 17 2,144.00 CR Balance oy 2,144,00 Adjustments/Credits Summary Adjustments to Previous Balance 0.00 Total Adjustments ' 000 Current Charge Summary Monthly Charges 2,144.00 One-Time Charges 0.00 Usage Charges 0.00 Discount 0.00 Adjustments 0.00 S LT R B A Taxes, Fees, and Surcharges 0,00 e S T e Total Current Charges o (21se00) adprense Pl @ Due Date Sep. 22,2016 Amount Due 4.288.00 X e PR Just a friendly reminder that your account Is past due. If you have already made your payment, thank you for bringing your account up to date. @“@%A’ @“7 OWH - 5Hi00 < *"PLEASE FOLD, TEAR HERE AND RETURN THIS PORTION WITH YOUR PAYMENT*** FOR CHANGE OF ADDRESS OR PAYMENT AUTHORIZATION: D Pleasg check here and complete reverse. Thank You. OKALOOSA COUNTY FINANCE DEPT ATTN: ROBERT CARD 302 N WILSON ST STE 220 CRESTVIEW, FL 32536-3474 Account Number: Amount Due By Sep. 22, 2016 Centurylink P.O. Box 1319 Charlotte, NC 28201-1319 311202851 4,288.00— 000031 1202851400000021440040000000000901 16000042880086000000 P.O. Box 1319 Charlotte, NC 28201-1319 Account Name: OKALOOSA COUNTY FINANCE DEPT Account Number: 311202851 Page: 2 of 8 Bill Date: Sep. 01, 2016 Important Notices and Information : Allocation of charges: Service Categories Past Due Current Month Total Due Basic Services 1,010.00 1,010.00 2,020.00 Other Services 1,134.00 1,134.00 2,268.00 All Services 2,144.00 2,144.00 4,288.00 Failure to pay Basic charges may result in the disconnection of those Services. Please contact CenturyLink regarding any questions or problems with your bill before the due date. Third-Party Billing Block Cramming occurs when unauthorized cha party charges on your bill, contact Centu rges