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Okaloosa County BOCC — September 3, 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
DATE: 10/9/2013
VENDO R FORT WALTON CONCRETE VENDOR #: 2982
y
CONTRACT/LEASE#: C02-0732-PW "
VENDOR TASK COUNTY/FEMA | BUDGET
ORDER # PROJECT # DEPARTMENT | ACCOUNT # AMOUNT $
INVOICE # . :
Cf Applicable) (Uf Applicable) N. H # .
65015 3201- ¥ 553010 440.00
BOL ZOS 1000
Total 440.00
APPROVED FOR PROGRESS PAYMENT (please sign, as applicable and date)
CONTRACTOR'S ENGINEER/ARCHITECT/PROJECT MANAGER: DATE:
Cbay DV pester cs DATE: Lo f14 fn
John Hofstad DATE: ie 23
DATE:
COUNTY SUPERVISOR/PROJECT MANAGER:
DEPARTMENT DIRECTOR: CL2¢ 7S
CONTRACTS & GRANT MANAGER.
COUNTY ADMINISTRATOR: DATE:
(Payments>$25,000,)
eee : : 1]
FINAL PAYMENT
FINAL PAYMENT — YIES Jr __ (Of "Yes", forward to Purchasing Services Coordinator for Close-Out)
DATE: PURCHASING DIRECTOR:
{Per Initial Agreement)
PE DATE: {Q- BAAS CONTRACTS & GRANTS MANAGER: K corr fh on Radu
"(All Contracts) . J
DATE: sf |x Nye COUNTY ADMINISTRATOR APPROVALE Ed ef - GA
7 —" (Per Initial Agreement) 0g
DATE: BOARD APPROVAL:
(Per Initial Agreement)
COMPLETED BY FINANCE - ACCOUNTS PAYABLE ONLY
FISCAL YEAR:
DATE RECEIVED:
REVIEWD BY:
ZIBS