Okaloosa County BOCC — May 17, 2016 — Contract - Lease Payment Approval Form - Final Payment

CONTRACT/LEASE PAYMENT APPROVAL FORM COMPLETE AND FORWARD TO THE NEXT DEPARTMENT = — —————— COMPLETED BY DEPARTMENT DATE: 5/6/2016 VENDOR NAME: Michael Baker International F/K/A The LPA Group , Inc. VENDOR #: 014750 CONTRACT/LEASE#: C09-1736-AP Bag Lift for "B" Gates TASK COUNTY/FEMA 1]:,5211)(?5 # ORDER # PROJECT # DEPBAIIJz];?\;/[Iile\JT g | OROUNTR AR (If Applicable) (if Applicable) 941277-15 Final 16 AE 741417 562463 450.00 941277-15 Final 16 4F, 741417 562463 25.00 941277-15 Final 16 hF 741417 562463 25.00 TOTAL | $ 500.00 APPROVED FOR PROGRESS PAYMENT (please sign, as applicable and date) CONTRACTOR'S ENGINEER/ARCHITECT/PROJECT MANAGER: DATE: COUNTY SUPERVISOR/PROJECT MANAGER: Stephanie Herrick DATE: ”l [l M DEPARTMENT DIRECTOR: "/E@— DATE: S+l >%€ONTRACTS & GRANT MANAGER; //%M% ta%ME M pATE: D- // COUNTY ADMINISTRATOR: ( DATE: (Payments>$25,000.) FINAL PAYMENT FINAL PAYMENT YES__ NO__ (If "Yes", forward to Purchasing Services Coordinator for Close-Out) DATE: 5716 PURCHASING DIRECTOR: %@M@ % [ | (Per Initial Agreement) U Q‘SIDATE; I A CONTRACTS & GRANTS MANAGER: (A1l Contracts) DATE: \flfi// A COUNTY ADMINISTRATOR APPROVAL: 74 4 (Per Initial Agreement) DATE: BOARD APPROVAL: (Per Initial Agreement) COMPLETED BY FINANCE - ACCOUNTS PAYABLE ONLY FISCAL YEAR: DATE RECEIVED: REVIEWED BY