Okaloosa County BOCC — October 5, 2013 — PMA Task Order 75 — reading text

Source Justification: Publication is the market's monthly lifestyle magazine targeted to affluent households of $75,000+ HHI | Ae £ 2Lialt3 | R ti ti it Head Si. if Dat R Regyesing PonarimgA Head Sonate 2D pee CTED REVIEW BY ‘CHA: DEPARTMENT VERIFY IF OTHER SOURCES OF SUPPLY MEETS THIS NEED Vendor #1 Contact: Phone No.: Vendor #2 Contact: Phone No.: Vendor #3 Contact: Phone No.: Buyer Comments: Signature of Buyer Who Reviewed Date Purchasing Services Manager Comments: Purchasing Services Manager Signature Date PURCHASING MANUAL - SINGLE SOURCE DETERMINATION Comments: Approve: Disapprove: Amount Lh e: Date: aes Cha 09-24-43 Purchasing Director Signature Date Revised — 11/09/98, 03/21/00, 09/18/01, 03/19/02, 09/07/04, 05/15/07, 09/04/07, 09/03/08, 09/12/2011 19 SINGLE SOURCE PURCHASE DATA SHEET Date: 9/10/2013 PR No.: Requestor: Peter Mayer Phone No. : 504.581.7191 Department/Division: — Tourist Development Department (TDD) Item Description: Pensacola Magazine - November Full Page 4C insertion Requesting Department's Suggested Vendor: OMOT Incorporated Vendor's Address: 41 N. Jefferson Street, #402, Pensacola, FL, 32502 Vendor's Telephone No.: 850.433.1166 Point of Contact: Sharyon Miller Sole Source Justification: Publication is the market's monthly lifestyle magazine targeted to affluent households of $75,000+ HHI he bill Signature << Z bale a EYE Foor ies DEP. VERIFY IF OTHER SOURCES OF SUPPLY MEETS THIS NEED Vendor #1 Contact: Phone No.: Vendor #2 Contact: Phone No.: Vendor #3 Contact: Phone No.: Buyer Comments: Purchasing Services Manager Comments: Signature of Buyer Who Reviewed Date Date Purchasing Services Manager Signature PURCHASING MANUAL - SINGLE SOURCE DETERMINATION Comments: Approve: A Disapprove: Amount of Purghgse: Date: Midas o9-04-19 Purchasing Director Signature Date Revised — 11/09/98, 03/21/00, 09/18/01, 03/19/02, 09/07/04, 05/15/07, 09/04/07, 09/03/08, 09/12/2011 19 SINGLE SOURCE PURCHASE DATA SHEET Date: 9/10/2013 PR No.: Requestor: Peter Mayer Phone No.: 594.581.7191 Department, / Division: Tourist Development Department (TDD) Item Description: Mobile Bay Monthly - November Full Page 4C insertion Requesting Department's Suggested Vendor: MOT Incorporated Vendor's Address: _ ?.0. 80x 66200, Mobile, AL, 36660 Vendor's Telephone No.: 251.473.6269 Point of Contact: 1. Potts Sole Source Justification: Publication is the market’s monthly lifestyle magazine targeted to affluent households of $75,000+ HHI REVIEW BY PURCHA: VERIFY IF OTHER SOURCES OF SUPPLY MEETS THIS NEED Vendor #1 Contact: Phone No.: Vendor #2 Contact: Phone N Vendor #3 Contact: Phone No.: Buyer Comments: Signature of Buyer Who Reviewed Date Purchasing Services Manager Comments: Purchasing Services Manager Signature Date PURCHASING MANUAL - SINGLE SOURCE DETERMINATION Comments: Approve: Disapprove: Amount of Rurgh, Date: Oatty Purchasing Director Signature Date Revised — 11/09/98, 03/21/00, 09/18/01, 03/19/02, 09/07/04, 05/15/07, 09/04/07, 09/03/08, 09/12/2011 19 SINGLE SOURCE PURCHASE DATA SHEET Date: 9/10/2013 PR No.: Requestor: Peter Mayer Phone No. ; 504.581.7191 Department/Division: — _Toutist Development Department (TDD) Item Description: Mississippi Magazine - November Full Page 4C insertion Requesting Department's Suggested Vendor: DMOT Incorporated Vendor's Address: _ ?.0. Box 16445, Jackson, MS, 39236 Vendor's Telephone No,: 601.982.8418 Point of Contact: Jane Foster Sole Source Justification: Publication is the market's monthly lifestyle magazine targeted to affluent households of $75,000+ HHI SOPAE 4 PS 1063 ni REVIEW BY P! HASItNG DEPARTMENT VERIFY IF OTHER SOURCES OF SUPPLY MEETS THIS NEED Vendor #1 Contact: Phone No.: Vendor #2 Contact: Phone No.: Vendor #3 Contact: Phone No.: Buyer Comments: Date Yat [3 Signature of Buyer Who Reviewed Date Purchasing Services Manager Comments: Purchasing Services Manager Signature Date PURCHASING MANUAL - SINGLE SOURCE DETERMINATION Comments: Approve: Disapprove: Amount of P: Date: 09-24-14 Purchasing Director Signature Date Revised — 11/09/98, 03/21/00, 09/18/01, 03/19/02, 09/07/04, 05/15/07, 09/04/07, 09/03/08, 09/12/2011 19 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, elecied 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. we NAME(S) POSITION(S) FIRM NAME: 2a te. Nets Ss BY (PRINTED): BY (SIGNATURE): TITLE: DATE: 0, rp orate. ADDRESS: De 01 Novthuied De “agice Rich mend, VA PHONE NO. 972-951-1099 E-MAIL 4 burns@® Statenets.com_ 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. a NAME(S) POSITION(S) FIRM NAME: V Sis FLORIDA BY (PRINTED): Lyater [ [ns BY (SIGNATURE): (GA S ies Contacts Myauuaceky DATE: | 29|20/ ADDRESS: ee “Pax 100 32307- PHONE NO. 850.705 28 al E-MAIL heollins Cvistftnnda 014 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. now NAME(S) POSITION(S) FIRM NAME: Alabama Mled ia Group BY (PRINTED): Deper K. PERRY BY (SIGNATURE): ) a TITLE: Sales Meunager DATE: G-Ad-| ADDRESS: a0 4 Ave Nowhh Birnoinaham, AL 39203 PHONE NO. Z05 a 2 -3345 ent dperry @ AL.com 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. : 4 NAME(S) POSITION(S) FIRM NAME: Cryuiews “b\tsh ag I t BY (PRINTED): Dove CofRn 3 BY (SIGNATURE): Dem Lf TITLE: Direchor ot Sales LE Markers DATE: 04) a3 } 20)\3 ADDRESS: BIO Nanay Lyne Ln, Sythe 2 Vavevelle aN 379149 PHONE NO. BLS- 640 -Brov (oS 7176-9396) 1 Com HY Via Com E-MAIL 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: Vaslui le ld Bhs lee Meajeve BY (PRINTED): Brion Raviy BY (SIGNATURE): iN TITLE: Pebi DATE: 9-737 138 ADDRESS: San aw ree ALothull<, Ta 22224 PHONE NO. LIS 259 3636 E-MAIL Vitn © ne rh ys Se 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_X NAME(S) POSITION(S) FIRM NAME: TEXAS MONTHLY BY (PRINTED): Whi Mey Dick BY (SIGNATURE): Wiko Die TITLE: Accom Divecbr DATE: 4 / 23 / 2013, ADDRESS: P.0. Bex 1S69 Pushin Texas E767 PHONE NO. 454 443.7311 E-MAIL wdick Gemmis publishing com T St 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. vie YES. NOw FF" NAME(S) POSITION(S) FIRM NAME: BY (PRINTED): BY (SIGNATURE): TITLE: DATE: 4\23 \ya ADDRESS: Lo Nekrans Plud Sule tra Wav. Asvos PHONE NO, D4 - Bas-\3¥0 EMAIL exiue- (2 Mango eens com 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. X___ NAME(S) POSITION(S) FIRM NAME: Louisville Magazine BY (PRINTED): Stacey Halahan. fe BY (SIGNATURE): TITLE: Advertising Director DATE: 9/23/13. ADDRESS: _137 W Louisville, KY 40202 PHONE NO. 502-625-0100, ext. 32 EMAIL shallahan@loumag.com Sep 20 13 08:36a Dottie Cesario 8138306118 p.1 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 a'so associated with your business}, or “no. If yes, give person(s) name(s) and position(s) with your business. YES__ — NO__No Conflicts as described above __ NAME(S) POSITION(S) FIRM NAME: Clear Channel Media & Entertainment - Birmingham BY (PRINTED): Dottie Cesario a» rT ee ? hae BY (SIGNATURE): Qsti. Corre THLE: Regional Account Manager DATE: 2/20/13 ADDRESS: $00 W Beacon Parkway, Suile 400 Birmingham, AL 35209 PHONE NO. 813-989-2934 E-MAIL DottieCesario@clearchannel.com