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Okaloosa County BOCC — September 16, 2014 — Peter Mayer Task Order 148 $546,475.00 081214 — reading text
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PURCHASING MANUAL - SINGLE SOURCE DETERMINATION
Comments:
Approve: Zz / _ Disapprove:
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Amount of Purchase: Date:
Abu ssttinal 8 ide
Purcha ing Director Signature Date ’
hay Zahy tele Cai ‘a
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 ousiness.
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. ae
NAME(S) POSITION(S)
FIRM NAME: Ken fr L Jum Cas, Lg
BY (PRINTED): Tm bist E02 Ala
BY (SIGNATURE): Abt l= —_
TITLE: Cencek Mpsecec
DATE: ¥/. Pt Lig.
ADDRESS: Zaee Ciecea ha
Theramaste, £6 32310.
PHONE NO. WSO - 34 Hoo
E-MAIL han kk aed’ A Ms R30 (0. Com