Okaloosa County BOCC — December 31, 2012 — Romjue Contract Close out form

EXHIBIT H CONTRACT CLOSE-OUT CHECKLIST (To Be Prepared by the Contracts & Leases Coordinator) pate: _///29//2 TO: Contracts & Grants Manager, Finance Department Contracts & Grants Division SUBJECT: Contract No._CO7-/5Y)-74P MANAGING DEPARTMENT: Lhe purrs CONTRACTOR'S NAME: Du re [eit Hve PRosecT Tite: = Va 7Z Papot tperhiin The attached has met the final payment contract requirement in subject contract. Yes No 1. Final Invoice ae LJ 2. Completed Contract/Lease Payment Approval Form QW L] 3. Close-Out Documents Yes No N/A a. Signed Release of Lien C] L] ra b. Proof of Completion Advertisement C] C] [4 c. Certificate of Insurance L] C] [1 d. Consent of Surety to Final Payment _] L] [4 e. Proof of Performance/Payment Bond C] L] [4+ Continuation 12 Months Following Final Payment Yes No 4. Agenda Request oe OO 5. Remarks WW4ij4a B/D ntraetS and Lease Coordinator DATE