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Okaloosa County BOCC — 2013 meeting #1140 (date undetermined) — Coordination Sht & Lease Renewal for EC Wildlife Ref — reading text
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= CONTRACT | LEASE INTERNAL COORDINATION SHEET
Contract/tease Number: 4/0- “Lio-3ofe. ~ Tracking Number: bt/2-13
Contractor/Lessee Name: Emerald Casi Ld bike Kehyescy Funded: YES__ NO” ~
Purpose: Soace Lease of--Obelwa» Lslaad hive Shon fay
Daie/Term: Fines. b Dales - / Yen LO GREATER THAN $50, 000
Amount: 4 L 02 7 2, (1 GREATER THAN $25,000
Geperiment fablic libs dukes 3, [24$25,000 OR LESS
Dept. Monitor Name: _ J. bofehd ad [lr _ -
Document has been reviewed and includes any attachments or exhibits. |
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Purchasing Review
Counly Alforney Review
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______ Following Okaloosa County approval: —
Contracts & Grants
Document has been received:
Contracts & Grants Manager _ a
CONTRACT/LEASE RENEWAL FORM
Date: May 16, 2013
Company Name: Emerald Coast Wildlife Refuge, Inc.
Attn: _Amanda Wilkerson
Address: 105 Santa Rosa Blvd.
City, State, Zip: Ft. Walton Beach, FL 32548
RE: One year Renewal Request
Dear Ms. Wilkerson:
The Okaloosa County agrees to renew the subject contract/lease, # L10-0371-PW for
an additional one year term. The contract renewal period will be offo, to
& [30 (2014 . The annual budgeted amount for this contract is $1.00.
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
Contractor: gmmaun cna Dapene pple, Oe
Approved By: _: : : Approved By :
(as prescribed below on item 1) TERRY PIELUTS
Title: Public. Works Director Tile: OAD thes l Mel
Date:_O5 -O\-\% pate: «| ve_ Z FOZ
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 Certificate 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. -
642-13