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Okaloosa County BOCC — September 3, 2013 — payment approval form — reading text
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FY AA
CONTRACT/LEASE
PAYMENT APPROVAL FORM
COMPLETE AND FORWARD TO THE NEXT DEPARTMENT
COMPLETED BY DEPARTMENT
DATE: 10/1/2013
VENDOR NAME: CH2M HILL Engineers, INC. VENDOR #: 15696
CONTRACT/LEASE#: C05-1188-WS
TASK COUNTY/FEMA
VENDOR BUDGET
INVOICE # ORDER # PROJECT# — | yepaRTMENT #| ACCOUNT # AMOUNT $
(ff Applicabie) Cf Applicable) J
38113026463 / 19 # 4120 ~| 563309 ~ 5,092.40
TOTAL | $ 5,092.40 ha
APPROVED FOR PROGRESS PAYMENT (lease sign, as applicable and date)
CONTRACTOR'S ENGINEER/ARCHITECT/PROJECT MANAGER: Coad Wee DATE: (UMS
COUNTY SUPERVISOR/PROJECT MANAGER: ZEA Oo Stank Ti bUise, DATE: sofofi2
DEPARTMENT DIRECTOR: YY al "Nal DATE: 10/ 0/ 2.613
CONTRACTS & GRANT MANAGER: DATE:
COUNTY ADMINISTRATOR: DATE:
(Payments>$25,000.)
FINAL PAYMENT
FINAL PAYMENT YES no Cf "Yes", ferward to Purchasing Services Ceerdinator for Close-Out)
0
DATE: PURCHASING DIRECTOR: tafer
(Per Initial Agreement)
(IE DATE: LO-a A-13 CONTRACTS & GRANTS MANAGER: Prd WS ada.
(All Contracts)
DATE: Vik J; /2 COUNTY ADMINISTRATOR ee LE
(Per Initial Agreement)
DATE: BOARD APPROVAL: 7 |
(Per Initial Agreement) a oe
COMPLETED BY FINANCE - ACCOUNTS PAYABLE ONLY
FISCAL YEAR:
DATE RECEIVED:
REVIEWED BY: