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Okaloosa County BOCC — April 27, 2013 — reading text
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PROJECT TITLE:
The attached has met the final payment contract requirement in subject contract.
Yes No
1. Final Invoice
2. Completed Contract/Lease Payment Approval Form
3. Close-Out Documents Yes No N/A
a. Signed Release of Lien
b. Proof of Completion Advertisement
c. Certificate of Insurance
d. Consent of Surety to Final Payment
e. Proof of Performance/Payment Bond
Continuation 12 Months Following
Final Payment
Yes No
4. Agenda Request
5. Remarks
______________________________ __________________________
Purchasing Services Coordinator DATE
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CONTRACT/LEASE
PAYMENT APPROVAL FORM
COMPLETE AND FORWARD TO THE NEXT DEPARTMENT
COMPLETED BY DEPARTMENT
DATE: ___________
VENDOR NAME: _____________________________________ VENDOR #: _________________
CONTRACT/LEASE #: _________________________________
Attachment: Compare version 5 with original.pdf (1517 : Revisions to the Purchasing Manual)
VENDOR TASK COUNTY/FEMA BUDGET ACCOUNT # AMOUNT $
INVOICE# ORDER # PROJECT # DEPARTMENT #
(If Applicable) (If Applicable)
TOTAL
APPROVED FOR PROGRESS PAYMENT (please sign, as applicable and date)
CONTRACTOR’S ENGINEER/ARCHITECT/PROJECT MANAGER: _____________________________ DATE:
_____________
COUNTY SUPERVISOR/PROJECT MANAGER: ____________________________________________ DATE:
______________
DEPARTMENT DIRECTOR: _____________________________________________________________ DATE:
______________
CONTRACTS & GRANTS MANAGER: ___________________________________________________ DATE:
_____________
COUNTY ADMINISTRATOR: ___________________________________________________________ DATE:
______________
(Payments>$25,000.)
FINAL PAYMENT
FINAL PAYMENT YES_____ NO_____ (If “Yes”, forward to Purchasing Services Coordinator for Close-Out)
DATE: ________ PURCHASING DIRECTOR ________________________________________________
(Per Initial Agreement)
DATE: ________ CONTRACTS & GRANTS MANAGER _______________________________________________
(All Contracts)
DATE: ________ COUNTY ADMINISTRATOR APPROVAL _______________________________________________
(Per Initial Agreement)
DATE: ________ BOARD APPROVAL _______________________________________________
(Per Initial Agreement)
COMPLETED BY FINANCE – ACCOUNTS PAYABLE ONLY
FISCAL YEAR: ____________
DATE RECEIVED: ___________________________
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REVIEWED BY: ____________________________________
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Attachment: Compare version 5 with original.pdf (1517 : Revisions to the Purchasing Manual)
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CONTRACT/LEASE
PAYMENT APPROVAL FORM
INSTRUCTIONS
Contract/Lease (Agreement) Payment Approval Form must be used for any lease or contract
payment
Attachment: Compare version 5 with original.pdf (1517 : Revisions to the Purchasing Manual)
Department 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
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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.
Attachment: Compare version 5 with original.pdf (1517 : Revisions to the Purchasing Manual)
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.
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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)
___________________________________________________________________________________________ _____
Attachment: Compare version 5 with original.pdf (1517 : Revisions to the Purchasing Manual)
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
