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Okaloosa County BOCC — August 6, 2013 — Payment Approval Form — reading text
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CONTRACT/LEASE
PAYMENT APPROVAL FORM
COMPLETE AND FORWARD TO THE NEXT DEPARTMENT
COMPLETED BY DEPARTMENT
pate: 09/09/2013
VENDOR NAME: Emerald Coast CAC VENDOR #:
CONTRACT/LEASE#; C©12-1998-CA
TASK COUNTY/FEMA
VENDOR BUDGET
INVOICE # ORDER # PROJECT # DEPARTMENT #| SCCOUNT# AMOUNT $
(If Applicable) (If Applicable)
April, 2013 WL 701393 534900 $ 1,569.49
May, 2013 [AK], 701393 534900 $ 785.68
TOTAL $ 2,355.17
APPROVED FOR PROGRESS PAYMENT (please sign, as applicable and date)
CONTRACTOR'S ENGINEER/ARCHITECT/PROJE DATE:
COUNTY SUPERVISOR/PROJECT MANAGE Wan pV DATE: 09/23/2013
DEPARTMENT DIRECTOR: DATE: Sas >
CONTRACTS & GRANT MANAGER: DATE:
COUNTY ADMINISTRATOR: DATE:
(Paymenis>$25,000.)
FINAL PAYMENT
FINAL PAYMENT Y esl¥ lol _ | Cf "Yes", forward to Purchasing Services Coordinator for Close-Out)
DATE: PURCHASING DIRECTOR:
(Per Initial Agreement)
PE DATE: Q-2A6-\3 CONTRACTS & GRANTS MANAGER: [PX
(All Contracts)
DATE: lo- $ AS COUNTY ADMINISTRATOR APPROVALS
(Per Initial Agreement) y
DATE: BOARD APPROVAL:
(Per Initial Agreement)
COMPLETED BY FINANCE - ACCOUNTS PAYABLE ONLY
FISCAL YEAR:
DATE RECEIVED:
REVIEWD BY: