Okaloosa County BOCC — April 27, 2013 — Compare version 5 with original — reading text

Responsibilities: 1. Initiates the Payment Approval Form completion process by completing Department section and then forwarding to the Contracts & Grants Manager for Progress Payments only. For final payments, see section 7 below. 2. Identifies the Vendor/Contractor Name and Vendor Number. 3. Lists the contract/lease number. 4. Attach the Vendor/Contractor invoice along with all supporting documentation for a pre and post audit. This must be an invoice and not a statement. If pursuant to a task order contract, invoice should reference task order number, authorized amount, prior paid amount, current amount due and task order balance remaining. 5. Identify appropriate budget, account and amount information for payment. 6. Obtain approval of all signatories approving this payment, as identified below. a. Contractor’s Engineer/Architect/Project Manager: Signs the form verifying that the work on the invoice has been completed in accordance with the terms and conditions of the agreement. b. County Supervisor/Project Manager: A County-designated employee or consultant signs the form verifying that the work on the invoice has been completed in accordance with the terms and conditions of the agreement and that the payment request on the invoice is proper and due. c. Department Director: Signs the form verifying that the work on the invoice has been completed in accordance with the terms and conditions of the agreement, including verification of contract rates, and that the funds are appropriately budgeted and available. Signs and approves all payments including final payment. 7. Final payments shall be forwarded to the Purchasing Services Coordinator for final payment authorization and close-out in accordance with the policies and procedures herein. Finance Department Contracts & Grants Office Responsibilities: 1. Finance Department Contracts & Grants Office signs the form verifying that an original agreement is on file in the Clerk’s Office and that the accounting codes are appropriate. 2. Finance Department Contracts & Grants Office shall forward all fully executed forms for progress payments up to and including $25,000 to the Accounts Payable Department who 41  verifies the form(s) have all the required approvals and signatures prior to authorizing payment. 3. Finance Department Contracts & Grants Office forwards to the County Administrator to sign and approve all progress payments in excess of $25,000. County Administrator also signs final payments for contracts initially authorized by him/her. Fully executed forms are forwarded to Finance Accounts Payable Department, which shall verify that the form includes all the required approvals and signatures before authorizing payment. 4. Finance Department Contracts & Grants Office shall forward the fully executed Final Payment forms from the Purchasing Director who signs and approves only the final payments on initial contracts authorized by him/her to Finance Accounts Payable Department for review and payment. 5. Finance Department Contracts & Grants Office forwards all other final payments for contracts initially authorized by the Board BCC Records in support of the agenda for Board approval. Fully executed forms are forwarded to Finance Accounts Payable Department for review and payment. 42  NOTICE OF COMMENCEMENT STATE OF FLORIDA COUNTY OF OKALOOSA The undersigned hereby informs all concerned that improvements will be made to certain real property and, in accordance with Section 713.13 of the Florida Statutes; the following information is stated in this NOTICE OF COMMENCEMENT: LEGAL DESCRIPTION OF PROPERTY TO BE IMPROVED (If lengthy, attach copy) ___________________________________________________________________________________________ _____ Street Address (if any) ___ ____ __ General Description of Improvements___ _________________________________________________________ Owner Okaloosa County Board of County Commissioners Owner's Interest__100%___ Address__302 N. Wilson St., Crestview, Florida 32536 ______________ Fee Simple Title Holder (If other than Owner)__NA Address__NA GENERAL CONTRACTOR Name__ Address__ Surety Bond__NA Address__NA Amount of Bond $__NA NAME AND ADDRESS OF FINANCIAL INSTITUTION MAKING A LOAN FOR THE CONSTRUCTION OF THE ABOVE IMPROVEMENTS Name__NA Address__NA PERSONS WITHIN THE STATE OF FLORIDA DESIGNATED BY OWNER UPON WHOM NOTICES OR OTHER DOCUMENTS MAY BE SERVED AS PROVIDED BY SECTION 713.13(1)(a)7, FLORIDA STATUTES Name Finance Department Contracts & Grants Office Address Clerk of Courts, 1804 Lewis Turner Blvd., Ft. Walton Beach FL 32548 IN ADDITION TO HIMSELF, OWNER DESIGNATES THE FOLLOWING PERSON TO RECEIVE A COPY OF THE LIENOR'S NOTICE AS PROVIDED IN SECTION 713.13(1)(b), FLORIDA STATUTES (FILL IN AT OWNER'S OPTION). Name Purchasing Services Coordinator Address 602-C North Pearl Street, Crestview, FL 32536 EXPIRATION DATE OF NOTICE OF COMMENCEMENT (THE EXPIRATION DATE IS 1 YEAR FROM THE DATE OF RECORDING UNLESS A DIFFERENT DATE IS SPECIFIED). _________________________________________________________________________________________________________ THIS SPACE FOR RECORDER'S USE ONLY I attest to the correctness of the information above. _________________________________________________ Authorized Department Signature The foregoing instrument was acknowledged before me this _____ day of _________________, 20___, by ____________ ______________________, who is personally known to me or who has produced ___________________________ as identification and who did/did not take an oath. _________________________________________________ 43  NOTARY PUBLIC _________________________________________________ MY COMMISSION EXPIRES 44  TASK ORDER APPROVAL FORM CONTRACT #: TASK ORDER #: TASK ORDER AMOUNT: $__________________________ OFFERED BY CONSULTANT: FIRM’S NAME REPRESENTATIVE’S PRINTED NAME SIGNATURE TITLE DATE RECOMMENDED FOR APPROVAL APPROVED BY OKALOOSA COUNTY (Department Director) (Per Purchasing Manual) SIGNATURE SIGNATURE TITLE TITLE DATE DATE 45  CONTRACT/LEASE RENEWAL FORM Date: Company Name Attn: Address City, State, Zip RE: Dear : The Okaloosa County agrees to renew the subject contract/lease, # for an additional term. The contract renewal period will be ____ to . The annual budgeted amount for this contract is $______________. 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). COUNTY REPRESENTATIVES AUTHORIZED COMPANY REPRESENTATIVE Dept. Director Contractor: ______ Signature: Approved By: Approved By: (as prescribed below on item 1) Title: Title: Date: Date: County Department Instructions: 1) Obtain signatures from Department Director, authorized Company Representative and then Purchasing Director <$25K and less, County Administrator <$50K and less or Board >$50K, as necessary. Make sure the company provides a current Certificate of Insurance. (If applicable). 46 2) Keep a copy of this form for your records. 3) Send original to Purchasing Services Coordinator. If you have any questions please contact the Purchasing Director at 850-689-5960, Fax: 850-689- 5998. 47  OKALOOSA COUNTY BOARD OF COUNTY COMMISSIONERS COUNTY ISSUED WIRELESS COMMUNICATION DEVICE USAGE AGREEMENT CERTIFICATION COUNTY OFFICIAL/EMPLOYEE CERTIFICATION I hereby certify by my signature that I have been provided a copy of the County policy for Wireless Communication Device; that I have read and understand the requirements contained therein; and that I agree to comply with the requirements of the policy as now written or amended in the future. Printed Name of Authorized User: Signature of Authorized User: Date: _____________ Name of Department: Type of Equipment Requested: CIRCLE ALL THAT APPLY Smart Phone, PDA (Blackberry), Cellular, Push to Talk Radio (Link), Pager, Air Card APPROVED BY: Department Director’s Signature: Date: Requesting Department complete the following information & fax to: Purchasing Dept. @ 850-689-5970 Wireless Communication Device: Mfr Model Serial #: Wireless Telephone #: 48  CONFLICT OF INTEREST DISCLOSURE FORM For purposes of determining any possible conflict of interest, all bidders/proposers, must disclose if any Okaloosa Board of County Commissioner, employee(s), elected officials(s), or if any of its agencies is also an owner, corporate officer, agency, employee, etc., of their business. Indicate either “yes” (a county employee, elected official, or agency is also associated with your business), or “no”. If yes, give person(s) name(s) and position(s) with your business. YES______________ NO______________ NAME(S) POSITION(S) FIRM NAME: _____________________________________ BY (PRINTED): _____________________________________ BY (SIGNATURE): _____________________________________ TITLE: _____________________________________ ADDRESS: _____________________________________ _____________________________________ PHONE NO. _____________________________________ E-MAIL _____________________________________ 49  NO CONTACT CLAUSE The Board has established