Okaloosa County BOCC — October 2, 2012 — Contract Payment Approval Form

CONTRACT/LEASE PAYMENT APPROVAL FORM COMPLETE AND FORWARD TO THE NEXT APPROVING DEPARTMENT COMPLETED BY DEPARTMENT DATE: 10/1/2012 VENDOR NAME: State Attorney's Office VENDOR #: 20500979 COUNTY AGREEMENT # (Contact Contract/Lease Coordinator, if unknown) C11-1918-SA TASK COUNTY/FEMA VENDOR ORDER # PROJECT # BUDGET INVOICE # (if applicable) (if applicable) DEPARTMENT# ACCOUNT # AMOUNT 12 IMIG “703294 201 $3490 2051000 $1,250.00 rea aire 012 Grant Expenses for Okaloosa County Victim's Advocate TOTAL $1,250.00 APPROVED FOR PAYMENT (please initial, as applicable and date): ENGINEER/ARCHITECT/PROJECT MANAGER \ DATE: COUNTY PROJECT MANAGER: DATE: | D i (2. DEPARTMENT HEAD: DATE: FINALPAYMENT:; YES \/ NO (= a CONTRACTS & GRANTS DATE: |O - 22-42 CONTRACTS & GRANTS MANAGER: BL DATE: COUNTY ADMINISTRATOR APPROVAL : (Only Payments $25,001 - $50,000) FINAL PAYMENT APPROVAL (if needed): PURCHASING DIRECTOR: (Only Contracts < = $25,000) COUNTY ADMINISTRATOR : (Only Contracts between $25,001 to $50,000) Contracts Over $50,000 — BCC Approved COMPLETED BY FINANCE - ACCOUNTS PAYABLE ONLY FISCAL YR: DATE RECEIVED: