Okaloosa County BOCC — January 6, 2015 — Fleet Cor

CONTRACT/LEASE RENEWAL FORM November 24, 2014 Mark Roberts - Director - Bids & Contracts U.S. Direct Issuing — Strategic Portfolio FLEETCOR TECHNOLOGIES 2015 Ayrsley Town Bivd., Suite 202 Charlotte, NC 28273 RE: Account BG181576 (CONTRACT #C11-1909-FLT) Dear Mr. Roberts The Okaloosa County Board of County Commissioners agrees to renew the subject contract/lease, #C11-1909-FLT for an additional term. The contract renewal period will be 10/5/2014 to 10/4/2015. The annual budgeted amount for this contract is $350,000.00. 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). © COUNTY REPRESENTATIVES AUTHORIZED COMPANY REPRESENTATIVE Dept Dlrect; . / o 7 Contractor: F/@&J‘ZW TIEc[ma/t’fif‘fé 2 4 fi/fl"flof fh7 (‘zym/a@ny - Ll ¢ Approved By: a 7 P Approved By: WM (as presc?d’_ below O}flem 1 y Approved Title:_ P/ vestor- Bifi{s' x Zé’mffa%;_ (as prescribed below on item 1) - . Date: ' Date:_ /2,//37//0_?”/‘7/' County Department Instructions: 1) Obftain signatures from Department Director, authorized Company Representative and ‘then Purchasing Director <$25K and less, County Administrator <$50K and less or Board >$50K, as necessary. If Board approval is required, the Chairman and County Administrator's signatfures . are required. Make sure the company provides a current Cerlificate of Insurance. (if applicable). 2) Keep a copy of this form for your records. 3) Send original to Purchasmg Services Coordinator. If you have any questions please contact the Purchasing Director of 850-689-5960, Fax: 850- 689-5998.