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Okaloosa County BOCC — September 3, 2013 — Exhibit C to 2013 CDC SHIP Administrative Services Agreement — reading text
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CONTRACT/LEASE
PAYMENT APPROVAL FORM
COMPLETE AND FORWARD TO THE NEXT DEPARTMENT
EXHIBIT
COMPLETED BY DEPARTMENT
DATE:
VENDOR NAME: VENDOR #:
CONTRACT/LEASE#:
TASK COUNTY/FEMA
voices | ORDER# | PROJECT# [pppaRtmeNta| ACCOUNT# | AMOUNTS
TOTAL $ 0.00
APPROVED FOR PROGRESS PAYMENT (please sign. as applicable and date)
CONTRACTOR'S ENGINEER/ARCHITECT/PROJECT MANAGER: DATE:
COUNTY SUPER VISOR/PROJECT MANAGER: DATE:
DEPARTMENT DIRECTOR: DATE:
CONTRACTS & GRANT MANAGER: DATE:
COUNTY ADMINISTRATOR: DATE:
(Payments $25,000.)
FINAL PAYMENT
FINAL PAYMENT
vest Wwol_| (If "Yes", forward to Purchasing Services Coordinator for Close-Out)
DATE: PURCHASING DIRECTOR:
(Per Initial Agreement)
DATE: CONTRACTS & GRANTS MANAGER:
(All Contracts)
DATE: COUNTY ADMINISTRATOR APPROVAL:
(Per Initial Agreement)
DATE BOARD APPROVAL:
(Per Initial Agreement)
E ee — : =|
COMPLETED BY FINANCE - ACCOUNTS PAYABLE ONLY
FISCAL YEAR:
DATE RECEIVED:
REVIEWD BY: