Okaloosa County BOCC — September 15, 2015 — FT WALTON CONCRETE RENEWAL

CONTRACT/LEASE RENEWAL FORM Date:7/8/2015 Fort Walton Beach Concrete/Crestview Re: Zac Sims 26 Industrial St. NW Fort Walton Beach, Florida 32548 RE:Contract Renewal Dear Zac Sims The Okaloosa County Board of County Commissioners agrees to renew the subject contract/lease, # C14-2105-PW for an additional term. The contract renewal period will be 10/1/2015 to 9/30/2016 . The annual budgeted amount for this confract is $250,000.00 . All other terms and conditions of the original agreement shall remain in full force and effect through the duration of this renewal. 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. Dire% Contractor: fens W ATy Con e ETHAC Signature: Date: \"2/)_5}12\) Approved By: / Approved By: Title: M A ALE (as prescribed below on item 1) Date: Date: 20y~ 090/ County Department Instructions: 1) Obtain signatures from Department Director, authorized Company Representative and then 2) 3) 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 signatures are required. Make sure the company provides a current Cerlificate of Insurance. (If applicable). Keep a copy of this form for your records. Send original to Purchasing Services Coordinator. If you have any questions please contact the Purchasing Director at 850-689-5960, Fax: 850- 689-5998. CONTRACT & LEASE INTERNAL COORDINATION SHEET Contract/Lease Number:L/L/ —r; Jés == PH} Tracking Number: /Vég e é Grant Funded: YES____ NO Contractor/Lessee Name: f %/7,.%1 W (orenats Purpose pp/fl_@(/v"kz/ Date/Term:_</ /57) // p 1. THaReaTeR THAN $50,000 77 jr— fi 0260‘_ g0 0 2. [ GREATER THAN $25,000 Department: 4 V\) 3. [] $25,000 0R LESS Dept. Monitor Name: Document has been reviewed and includ€s any attachments or exhibits. Purchasing Review Date: 7’)3'5- Joanne Kublik or Sunnie Estes + I . o Parchasing Director or Desnén/ee & 2 Risk Management Review (27/7 Date: AZ ;Q./ *'I.Q“ Laura Porter or Krystal King Approved as written: County Attorney Review Approved as written: \Q N Date:fi'&g'/r /Jntf@% Gregory T. Stewart or Lynn Hoshihara Following Okaloosa County approval: Contracts & Grants Document has been received: Date: Contracts & Grants Manager /