Okaloosa County BOCC — December 31, 2012 — Meridian Contract Close out form

EXHIBIT H CONTRACT CLOSE-OUT CHECKLIST (To Be Prepared by the Contracts & Leases Coordinator) DATE: /29/20)2 TO: Contracts & Grants Manager, Finance Department Contracts & Grants Division SUBJECT: Contract No. Cll- (3¢4-Gwm | MANAGING DEPARTMENT: Gvowns Mand cement CONTRACTOR'S NAME: Meridian Gommumtby Semus Grov? PROJECT TITLE: $= CDBG Program Administrafiw: Services The attached has met the final payment contract requirement in subject contract. Yes No 1. Final Invoice MY OC 2. Completed Contract/Lease Payment Approval Form M ia 3. Close-Out Documents Yes No N/A a. Signed Release of Lien C] C] fy d. Proof of Completion Advertisement L] LJ Ad c. Certificate of Insurance im Contract x LC] d. Consent of Surety to Final Payment L] CL] hx e. Proof of Performance/Payment Bond C) CJ Xf Continuation 12 Months Following Final Payment Yes No 4. Agenda Request x C 5. Remarks BE Jee W/23hye- ntraet$ and Lease Coordinator DATE