Okaloosa County BOCC — February 2, 2016 — Crosby contract final payment

CONTRACT/LEASE PAYMENT APPROVAL FORM COMPLETE AND FORWARD TO THE NEXT DEPARTMENT COMPLETED BY DEPARTMENT DATE: 1/26/2016 VENDOR NAME: Crosby Ice, LLC VENDOR #: 21300492 CONTRACT/LEASE#: L13-0398-AP TASK COUNTY/FEMA VENDOR BUDGET ORDER # PROJECT # ACCOUNT # AMOUNT $ INVOICE # (0f Applicable) (f Applicable) DEPARTMENT # 4202 544640 $ 27,000.00 TOTAL | $ 27,000.00 APPROVED FOR PROGRESS PAYMENT (please sign, as applicable and date CONTRACTOR'S ENGINEER/ARCHITECT/PROJECT MANAGER: DATE: COUNTY SUPERVISOR/PROJECT MANAGER: Department Director signing as DD & PM DATE: - TRACY STAGE A.A.E. DEPARTMENT DIRECTOR: /, P DATE: /:2¢& /¢ TRA! TAGE, A.A.E. - Interim Department Director CONTRACTS & GRANT MANAGER: DATE: COUNTY ADMINISTRATOR: DATE: (Payments>$25,000.) I; e — — = FINAL PAYMENT FINAL PAYMENT YES X NO (If ""Yes", forward to Purchasing Services Coordinator for Close-Out) pate: 7706 PURCHASING DIRECTOR: | m;% q/é ’ / (Per Initial Agreement) - DATE: /- 27-Z0/ CONTRACTS & GRANTS MANAGER: "/ (All Contracts) DATE: / /7'27// 6 COUNTY ADMINISTRATOR APPROVAL: il / (Per Initial Agreement) / DATE: BOARD APPROVAL: (Per Initial Agreement) t ——— 1| COMPLETED BY FINANCE - ACCOUNTS PAYABLE ONLY FISCAL YEAR: DATE RECEIVED: REVIEWED BY: