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