Okaloosa County BOCC — September 16, 2014 — Peter Mayer Task Order 148 $546,475.00 081214 — reading text

their business. Indicate elther “yes” (a counly employee, elected official, or agency is also associated with your business), or “no”, If yes, give person(s) name(s) and position(s) with your business. Ye NO NAME(S) POSITION(S) FIRM NAME: (i OMI | US BY (PRINTED): Gx. Si; fbewek at BY (SIGNATURE): ZZ) THLE: RVO /Mar tet Murmmser DATE: B-267/¥ ADDRESS: @3( Man Sfacet Caton Loe bf 7°90 v . 4 PHONE NO. (2253 236-3576 E-MAIL <Gesg bene Field@Camalas Com SINGLE SOURCE PURCHASE DATA SHEET Date: __‘| Id | PR No.: Requestor: Phone No.: 5045817191 Depariment/Division: Tourist Development Department (TDD) Item Description: 2014/2015 Media Plan TO 148 Requesting Department's Suggested Vendor: Cumulus - Lafayette Vendor's Address: 202 Galbert Rd, Lafayette, LA 70506 Vendor's Telephone No.: 337-408-9208 Point of Contact: Robin Chapman Sole Source Justification: Cumulus is the nation's second largest radio station operator; Lafayette is a primary target audience in the FY 2014/15 Strategic Marketing Plan adopted by TD0/& BGC; 3:1 ROI v \ MN ZF i a 08/01/2014 FL E [4 v4 7 Requesting Department\Head Signature Dat, REVIEW BY PURCHASING DEPARTMENT VERIFY IF OTHER SOURCES OF SUPPLY MEETS THIS NEED Vendor #1 Contact: Phone No.: Vendor #2 Contact: Phone No.: Vendor #3 Contact: Phone No.: Buyer Comments: Signature of Buyer Who Reviewed Date Purchasing Services Manager Comments: Purchasing Services Manager Signature Date PURCHASING MANUAL - SINGLE SOURCE DETERMINATION Comments: Approve: Z (— Disapprove: Pp on Amount of Purchase: Date: <2. 4 /) Cl z= afi in bebe 710 f 4 Purchasing Director Signature Date! Za) facto eek Revised — 11/09/98, 03/21/00, 09/18/01, 03/19/02, 09/07/04, 05/15/07, 09/04/07, 09/03/08, 09/12/2011 19 CONFLICT OF INTEREST DISCLOSURE FORM For purposes of determining any possible conflict of interest, all bidders/proposers, must disclose if any Okaloosa Board of County Commissioner, employee(s}, elected officials(s}, or if any of its agencies is also an owner, corporate officer, agency, employee, etc., of their business. Indicate elther "yes" (a county employee, elected official, or agency is also associated with your business), or"'no”. If yes, give person{s) name(s) and position(s) with your business. YES. NO L NAME(S) POSITION(S) FIRM NAME: Gran Les Wechce BY (PRINTED): Ae ni Wanna BY (SIGNATURE}: Lhe Cay bra— TITLE: S30 wOA Q he ou nt Prue Cu #10 DATE: 8 | 2-2 [AE ADDRESS: AND al lye rk kee . Yaelauette, [A 20506 PHONE NO. 253) — He - -4L.0 a E-MAIL aan nha Did iN OC 4 NAIM S: Com SINGLE SOURCE PURCHASE DATA SHEET ale |), { Date: 4 Ic I jt PR No.: Requestor: Phone No.: 5045817191 Department/Division: Tourist Development Department (TDD) Item Description: 2014/2015 Media Plan TO 148 Requesting Department's Suggested Vendor: Cumulus - Huntsville Vendor's Address: 806 Governors Dr SW Vendor's Telephone No.: 256-262-1201 Point of Contact: Cythia Bryce Sole Source Justification: Cumulus is the nation's second largest radio station operator; Huntsville is a phimary target audience in the FY CLE Strategic arketing Plan adopted v TD £3" ROI . VW Sce ’ 08/01/2014 ile Requesting Deparimept Head Lt REVIEW BY PURCHASING DEPARTMENT VERIFY IF OTHER SOURCES OF SUPPLY MEETS THIS NEED Vendor #1 Contact: Phone No.: Vendor #2 Contact: Phone No.: Vendor #3 Contact: Phone No.: Buyer Comments: Signature of Buyer Who Reviewed Date Purchasing Services Manager Comments: Purchasing Services Manager Signature Date PURCHASING MANUAL - SINGLE SOURCE DETERMINATION Comments: Approve: Disapprove: Amount of Purchase: Date: af metolie al a H com 4 Purchasing Direct Sig, atur Date eShasing Director Slant Revised — 11/09/98, 03/21/00, 09/18/01, 03/19/02, 09/07/04, 05/15/07, 09/04/07, 09/03/08, 09/12/2011 19 CONFLICT OF INTEREST DISCLOSURE FORM For purposes of determining any possible conflict of interest, all bidders/proposers, must disclose if any Okaloosa Board of County Commissioner, employee(s), elected officials(s), or if any of its agencies is also an owner, corporate officer, agency, employee, etc., of their business. Indicate either "yes" (a county employee, elected official, or agency is also associated with your business), or no". If yes, give person(s) name(s) and p sition(s) with your business. YES. NO. NAME(S) POSITION(S) FIRM NAME: mvs BY (PRINTED): Ota du (QD BY (SIGNATURE): TITLE: i $ W vows: {dv 7 UVES by ev AL 355 PHONE NO. ISU rd lad) E-MAIL Court rere (0 Cus _— SINGLE SOURCE PURCHASE DATA SHEET { Date: “TTS H aT) { v Department/Division: Tourist Development Department (TDD) |] U PRNo.: Requestor: Phone No.: 5045817191 Item Description: 2014/2015 Media Plan TO 148 Requesting Department's Suggested Vendor: Cumulus - Birmingham Vendor's Address: 244 Goodwin Crest, Birmingham, AL 35209 Vendor's reser No.: 205-945-4646 Point of Contact: Reade Taylor Sole Source Justification: Cumulus is the nation's second largest radio station operator; Birmingham is a oe tget audience in FY 2014/15 Strategic Marketing Plan adopted ay a 3:1 ROI rn SLC oso12014. 7 UY &) Requesting Departmen Head Signature Bate REVIEW BY PURCHASING DEPARTMENT VERIFY IF OTHER SOURCES OF SUPPLY MEETS THIS NEED Vendor #1 Contact: Phone No.: Vendor #2 Contact: Phone No.: Vendor #3 Contact: Phone No.: Buyer Comments: Signature of Buyer Who Reviewed Date Purchasing Services Manager Comments: Purchasing Services Manager Signature Date PURCHASING MANUAL - SINGLE SOURCE DETERMINATION Comments: Approve: ¥ — Disapprove: Amount of Purchase: Date: <b, Stlnal afi fi Purchasing Director Signature Date! ed Zan beclorake Revised — 11/09/98, 03/21/00, 09/18/01, 03/19/02, 09/07/04, 05/15/07, 09/04/07, 09/03/08, 09/12/2011 19 CONFLICT OF INTEREST DISCLOSURE FORM For purposes of determining any possible conflict of interest, all bidders/proposers, must clisclose if ony Okaloosa Board of County Commissioner, employee(s), elected officials(s), or if any of its agencies is also an owner, corporate officer, agency, employee, etc., of their business. Indicate either “yes” (a county employee, elected official, or agency is also associated with your business}, or "no". If yes, give person(s} name(s) and position(s) with your business. YES NO. WA NAME(S) POSITION(S) FIRM NAME: BY (PRINTED): Reade. Tay lew BY (SIGNATURE): Cage TITLE: ferns Shs Meaoger DATE: cy es fh 4 ADDRESS: 244 Goodwin Crk Birminghan AM SF%eM PHONE NO. Cedysr-re te E-MAIL Peace. Fey fe 7.0 tlw le b.c2 mm SINGLE SOURCE PURCHASE DATA SHEET lis] Date: 9 LS hi “| PRNo.: Requestor: Phone No.:5045817191 Tt Depariment/Division: Tourist Development Department (TDD) Item Description: 2014/2015 Media Plan TO 148 Requesting Department's Suggested Vendor: Cumulus - Montgomery Vendor's Address: Suite 300, One Commerce St, Montgomery, AL 36104 Vendor's Telephone’ Noy; 334-240-2248 Point of Contact: _Lanier Harris Sole Source Justification: Cumulus is the nation's second largest radio station operator; Montgomery is a primary target\audience in the FY 2014/15.SMP adopted by TDC & BCC; 3:1 RO; \ Ly 7 \ in eéhgrv 08/01/2014 a Date Requesting Department mt Signature \ -EVIEW BY PURCHASING DEPARTMENT VERIFY IF OTHER SOURCES OF SUPPLY MEETS THIS NEED Vendor #1 Contact: Phone No.: Vendor #2 Contact: Phone No.: Vendor #3 Contact: Phone No.: Buyer Comments: Signature of Buyer Who Reviewed Date Purchasing Services Manager Comments: Purchasing Services Manager Signature Date PURCHASING MANUAL - SINGLE SOURCE DETERMINATION Comments: Approve: 4F Disapprove: Amount of Purchase: Date: un tbr QUO [14 . . . A yn 7] Purchasing Director Signaluy obra Date Revised — 11/09/98, 03/21/00, 09/18/01, 03/19/02, 09/07/04, 05/15/07, 09/04/07, 09/03/08, 09/12/2011 19 CONFLICT OF INTEREST DISCLOSURE FORM For purposes of determining any possible conflict of interest, all bidders/proposers, must disclose if any Okaloosa Board of County Commissioner, employee(s), elected officials(s), or if any of its agencies is also an owner, corporate officer, agency, employee, eitc., of their business. Indicate either "yes" (a county employee, elected official, or agency is also associated with your business), or "no". If yes, give person(s) name(s) and position(s) with your business. YES. NO__XXXX_ NAME(S) POSITION(S) FIRM NAME: _ Cumulus Media/Montgomery BY (PRINTED): ‘Lanier W. Harris BY (SIGNATURE): WAALS \N 4 FORA, TITLE: _Key Account Manager DATE: 8/25/14 ADDRESS: Suite 300, One Commerce Street Montgomery AL 36104 PHONE NO. 334-240-2248 E-MAIL lanier.harris@cumulus.com SINGLE SOURCE PURCHASE DATA SHEET |), Date: A iS HA PR No.: Requestor: Phone No.: 5045817191 Department/Division: Tourist Development Department (TDD) Item Description: 2014/2015 Media Plan TO 148 Requesting Department's Suggested Vendor: Cumulus - Little Rock Vendor's Address: 700 Wellington Hills Road, Little Rock, AR 72211 Vendor's Telephone No.: 501-401-0200 Point of Contact: Gena Wilfong Sole Source Justification: Cumulus is the nation's second largest radio station operator; Little Rock is a ‘liner target audience in the FY 20141 |5 Strategic Marketing Plan adopted by TDC & BCC; 8:1 ROI G N DN SE 08/01/2014 WELLS 7 F Requesting naa Signature Date REVIEW BY PURCHASING DEPARTMENT VERIFY IF OTHER SOURCES OF SUPPLY MEETS THIS NEED Vendor #1 Contact: Phone No.: Vendor #2 Contact: Phone No.: Vendor #3 Contact: Phone No.: Buyer Comments: Signature of Buyer Who Reviewed Date Purchasing Services Manager Comments: Purchasing Services Manager Signature Date PURCHASING MANUAL - SINGLE SOURCE DETERMINATION Comments: Approve: L- Disapprove: [= Amount of Purchase: Date: Durvbtdral Q Jt fd Purchasing Director Signature Date Za] Fedorek Revised — 11/09/98, 03/21/00, 09/18/01, 03/19/02, 09/07/04, 05/15/07, 09/04/07, 09/03/08, 09/12/2011 19 CONFLICT OF INTEREST DISCLOSURE FORM For purposes of determining any possible conflict of interest, all bidders/proposers, must disclose if any Okaloosa Board of County Commissioner, employee(s), elected officials(s), or if any of its agencies is also an owner, corporate officer, agency, employee, etc., of their business, Indicate either “yes" (a county employee, elected official, or agency is also associated with your business), or "no". If yes, give person(s) name(s) and position(s) with your business. YES, No NAME(S) POSITION(S) FIRM NAME: Cumulus Radin Corporation BY (PRINTED): G ena Wilfang BY (SIGNATURE): Kha Wibpenp TITLE: Business Manager DATE: Slaalwy ADDRESS: 100 Weilington Hills Road Cite Role, RE Teast PHONE NO, 20\-UD- O00 E-MAIL —gena wilfong@ cumulus.coan SINGLE SOURCE PURCHASE DATA SHEET he Date: FIST prno.: Requestor: Phone No.; 5045817191 Lt t Department/Division: Tourist Development Department (TDD) Item Description: 2014/2015 Media Plan TO 148 Requesting Department's Suggested Vendor: Entercom Communications Vendor's Address: 800 Poydras Street, Suite 400, New Orleans, LA 70124 Vendor's Telephone Nd,: 504-250-5150 Point of Contact: Stephen Klein Entercom develops unique locally programmed stations & partners with the N.O. Sole Source Justification. Saints & Pelicans; v Orleai is a primary ee) audience in FY 2014/15 SMP adopted by TDC & 71 ROI oe: WN £LE LE 08/01/2014 Requesting Department Head Signature REVIEW BY PURCHASING DEPARTMENT VERIFY IF OTHER SOURCES OF SUPPLY MEETS THIS NEED Vendor #1 Contact: Phone No.: Vendor #2 Contact: Phone No.: Vendor #3 Contact: Phone No.: Buyer Comments: Signature of Buyer Who Reviewed Date Purchasing Services Manager Comments: Purchasing Services Manager Signature Date PURCHASING MANUAL - SINGLE SOURCE DETERMINATION Comments: Approve: AE Disapprove: — of Purchase: Date: 2 fbbeb Tied Purch hi Director Signature Date Zan Fedorak Revised — 11/09/98, 03/21/00, 09/18/01, 03/19/02, 09/07/04, 05/15/07, 09/04/07, 09/03/08, 09/12/2011 19 CONFLICT OF INTEREST DISCLOSURE FORM ’ For purposes of determining