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