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Okaloosa County BOCC — November 16, 2013 — Final Payment Form — reading text
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SS
CONTRACT/LEASE
PAYMENT APPROVAL FORM
COMPLETE AND FORWARD TO THE NEXT DEPARTMENT
—————————————
COMPLETED BY DEPARTMENT
DATE: 08/15/13
VENDOR NAME: City of Destin Harbor Maintenance Dredging © VENDOR #: 004710
CONTRACT/LEASE #: C13-2032-TDC
VENDOR TASK COUNTY/FEMA BUDGET ACCOUNT # | AMOUNT $
INVOICE# ORDER # PROJECT # DEPARTMENT #
(If Applicable) (Uf Applicable)
See Attached 1175 581719 $157,838.00
TOTAL $157,838.00
APPROVED FOR PROGRESS PAYMENT (Please sign as applicable and date)
CONTRACTOR'S ENGINEER/ARCHITECT/PROJECT MAN R:
DATE:
ia
——— CCL
COUNTY SUPERVISOR/PROJECT . SE LE \t AW od
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DEPARTMENT DIRECTOR: i Zot) Wy> Mn
hal c ee ca
hE CONTRACTS & GRANTS MANAGER: f
COUNTY ADMINISTRATOR:
Payments> $25,000.)
FINAL PAYMENT
FINAL PAYMENT YESSY NO___ (Of "Yes", forward to Purchasing Services Coordinator for Close-Out)
DATE: PURCHASING DIRECTOR
(Per Initial Agreement) y
DATE: A a | \2, CONTRACTS & GRANTS MANAGER (SS no inden Kr Qu
(All Contracts) . “ Sy
DATE: COUNTY ADMINISTATOR APPROVAL
(Per Initial Agreement)
DATE: BOARD APPROVAL
(Per Initial Agreement)
—sseae =|
COMPLETED BY FINANCE - ACCOUNTS PAYABLE ONLY
FISCAL YEAR:
DATE RECEIVED:
REVIEWED BY: