Okaloosa County BOCC — September 15, 2015 — FLEETCOR RENEWAL & COORDINATION

CONTRACT/LEASE RENEWAL FORM August 25, 2015 FLEETCOR TECHNOLOGIES Mark Roberts, Director Bids & Contracts 2015 Ayrsley Town Bldv., Suite 202 Charlotte, NC 28273 RE: Account BG181576 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 10/05/2015 to 10/04/2016 . The annual budgeted amount for this contract is $350,000.00 . 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 Cetlificate of Insurance listing Okaloosa County as co-insured (if applicable). COUNTY REPRESENTATIVES AUTHORIZED COMPANY REPRESENTATIVE Contractor: FleetCor Technologies Operating Company, LLC Approved By: %V/ %‘% Dept. Director / Signature: <&— fo a2 T _ = Date: 8'5/'20/5 /fl Approved By: (as prescribe Date: Approved By: Title:_Director - Bids & Contracts (as prescribed below on item 1) Date: Date:_August 25, 2015 County Department Instructions: 1) Obtain 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 signatures 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 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:__ (] | — )(T\D 7 "FZJ— Tracking Number:j_fii J4E1-15 ~ A Grant Funded: YES NO Fleercor — No_ Contractor/Lessee Name: . /) Purpose /L)/CdW Date/Term:___ /D / L/,/ J b 1. [] GREATER THAN $50,000 < Amount: q 3 .)OJ 270_5 2, D GREATER THAN $25,000 DepatiioRt, AT 3. [ $25,000 OR LESS Dept. Monitor Name: \/CIM-L?A;\ / KL/[I Document has been reviewed and includes any attachments or exhibits. Purchasing Review Prgcurement requlrem ents a e?e'( 7 é\ % C} j/\ // Date: S ) “ZJ Purchasmg Director or DeSIgnge Joanne Kublik or Sunnie Estes Risk Management Review Approved as written: Za TV YT pate;_ Q- -5 RisK Manager or deSIgnee Laura Porter or Krystal King County Attorney Review Approved as written: /\J) Q_ Date:fi'gs'/y Codnty Att y - Gregory T. Stewart or Lynn Hoshihara U/ Following Okaloosa County approval: Contracts & Grants Document has been received: Date: Contracts & Grants Manager