Okaloosa County BOCC — December 2, 2014 — Severn Trent Final Invoice

CONTRACT CLOSE-OUT CHECKLIST (To Be Prepared by the Contracis and Lease Coordinator) DATE: 11/07/2014 TO: Contracts & Grants Manager, Finance Department Contracts & Grants Office SUBJECT: ContractNo. C09-1767-WS MANAGING DEPARTMENT: WATER & SEWER CONTRACTOR'S NAME: SEVERN TRENT ENVIRONMENTAL SERVICES PROJECT TITLE: UTILITY BILL PRINTING The attached has met the final payment contract requirement in subject contract. Yes 1. Final Invoice : x] 2. Completed Contract/Lease Payment Approval Form Xd 3. Close-Out Documents Yes No a. Signed Release of Lien C] [_] b. Proof of Completion Advertisement Cc L] c. Certificate of Insurance CT] rl d. Consent of Surety to Final Payment C] ry e. Proof of Performance/Payment Bond ia CI Continuation 12 Months Following Final Payment Rg 4, Agenda Request 5. Remarks /I- )-14 No O A =z ~ IX iw LN XID XIX = ° Jodie Kubik, Contracts and Lease Coordinator . DATE CONTRACT/LEASE PAYMENT APPROVAL FORM COMPLETE AND FORWARD TO THE NEXT DEPARTMENT DATE: 11/3/2014 COMPLETED BY DEPARTMENT VENDOR NAME: SEVERN TRENT ENVIRONMENTAL SERVICES VENDOR #: 014669 CONTRACT/LEASE#: C09-1767-WS TASK COUNTY/FEMA VENDOR BUDGET ORDER # PROJECT # ACCOUNT # AMOUNT $ INVOICE # (Applicable) (f Applicable) DEPARTMENT # 2075709 4101 534306 15,590.29 TOTAL | $ 15,590.29 APPROVED FOR PROGRESS PAYMENT (please sign, as applicable and date) CONTRACTOR'S ENGINEER/ARCHITECT/PROJECT ay DATE: DEPARTMENT DIRECTOR: vi COUNTY SUPERVISOR/PROJECT MANAGER: ws DATE: lt). ay LaAAY Ju} Teer CONTRACTS & GRANT MANAGER: COUNTY ADMINISTRATOR: (Payments>$25,000.) DATE: _j{ [x for DATE: DATE: — FINAL PAYMENT FINAL PAYMENT YES v NO__ (if'"Yes", forward to Purchasing Services Coordinator for Close-Out) DATE: Whp2ye4e DATE: //-.20-20/ So CONTRACTS & GRANTS MANAGER: (Per Initial Agreement) PURCHASING DIRECTOR: om Stelerak Zan Fechral (All Contracts) = . ns ra DATE: WHA COUNTY ADMINISTRATOR APPROVAL: 4 PZ, Ga VA / (Per Initial Agreement) Yo p= hn Hofstad DATE: BOARD APPROVAL: (Per Initial Agreement) COMPLETED BY FINANCE - ACCOUNTS PAYABLE ONLY FISCAL YEAR: DATE RECEIVED: REVIEWED BY: "ob Mee 16337 Park Row SERVICES | Operating Services Houston, Texas 77084 Telephone 281 578 4200 Fax 281 398 3715 Severn Trent Environmental Services, Inc, SRO INVOICE: STES 2075709 Page: 1 Invoice Date: 10/01/14 Salesperson: SOLD TO 3-00180 JOAN WHITNEY OKALOOSA CO WATER & SEWER ATTN: FINANCIAL MANAGER SUITE 300 1804 LEWIS TURNER BLVD SHIP TO OKALOOSA CO WATER & SEWER ATTN; FINANCIAL MANAGER SUITE 300 1804 LEWIS TURNER BLVD FORT WALTON BEA FL 32547-1225 FORT WALTON BEA FIL. 32547=-1225 USA J USA REF Cust PO Ship Via Terms — $136103 Item: Unit Description Quantity u/M Price Extension BILLING CHARGES - SEPTEMBER 2014 OEM 28,111.00 7 FA 0.55 15,528.52 BILLS @ .5524 O&M -60 EA 0.55 0.00 FINALS @ .5524 O&M 5.00 “ BA 1.24 6.05 FOREIGN BILLS @ 1.21 POSTAGE O&M -00 ° BA 0.01 0.00 INSERTS @ .01 O&M .00 EA 0.55 0.00 MISC. OFF-CYCLE BILLS @ .5524 OsM :00 . EA : 0.00 0.00 SHIPPING CHARGES - O&M .00 EA 0.00 0.00 INSERT PRINTING-CCR'S 06M 00 «BA 0.00 0.00 PROGRAMMING CHARGES . O&M 140.00 EA 0.10 14,00 EXTRA POSTAGE - FILE UNDER 500 PIECES O&M 00 EA 0.00 0.00 SPEC MAILING O&M 4,172.00. EA 0.01 41.72 EBILLS @ 0.01 K he Sub Total: 15,590.29 Misc Charges: 0.00 Freight: 0.00 Tax Amount: 0.00 _ _ : _ Total: 15,590.29 DETACH AND RETURN WITH REMITTANCE Invoice: 2075709 Customer: 3-00180 OKALOOSA CO WATER & SEWER 15,590.29 REMIT TO: Severn Trent Environmental Services, Inc. Mail Gode 5167 P.O. Box 660367 . Dallas, TX 75266-0367 Remittance Amount OKALOOSA CYCLE 915 9/8 92 9/19 9/22 9/26 9/30 TOTAL BILLS CANADA FOREIGN FINALS 1,447 3 1 6,981 6,913 31 6,598 2 440 28,111 0 5 0 MISC 900 1,225 1,111 6 930 4,172