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Board of County Commissioners
Purchasing Department
State of Florida
July 19, 2013 CONTRACT RENEWAL FORM
Dr. Christopher D. Tanner, M.D.
P.O. Box 5500
Destin, FL 32540
RE: Contract #C09-1721-PS (Medical Director)
Dear Dr. Tanner:
The Okaloosa County Department of Public Safety wishes to renew the subject contract, #C09-1721-PS
for an additional term. The contract renewal period will be October 1, 2013, to September 30, 2014.
The annual budgeted amount for this contract is $16,000.00.
If you are in agreement, please sign below and return this form along with a current
Certificate of Insurance listing Okaloosa County as co-insured (if applicable) to: Okaloosa
County Public Safety, 90 College Boulevard East, Niceville, FL 32578.
COUNTY REPRESENTATIVES AUTHORIZED COMPANY REPRESENTATIVE
Director: Dino J. Villani, Pubtic-Safety Director~ Contractor: Dr. Christopher D. Tanner, M.D.
<
Director Signature;
County Official: Ka
Approved By: _ Don R. Amunds Approved By: adel wb
Title: Chaicmart Title: Medical Director,
Date: Date: 4/28 i)
County Department Instructions:
1) Obtain signatures from Department Director, authorized Company Representative and then
Purchasing Director <$25K, County Administrator <$50K or BCC Chairman >$50K, as
necessary. Make sure the company provides a current Certificate of Insurance. (If applicable)
2) Keep a copy of this form for your records.
3) Send original to; Jack Allen, Purchasing Services Manager.
If you have any questions please contact Jack Allen at 850-689-5960, Fax—850-689-5998, e-mail:
jallen@co.okaloosa.fl.us