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Okaloosa County BOCC — September 16, 2014 — AC-Form — reading text
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09-08-14A08:31 RCVD
CONTRACT/LEASE RENEWAL FORM
Date: August 18, 2014
4 : RCVD
Anderson Columbia, Inc. g9-05-14A10:07 S
Atin: Kevin Wall
1301-C West Highway 90
Holt, FL 32564
RE: Asphalt Materials Contract
Dear Kevin:
The Okaloosa County Board of County Commissioners, agrees to renew the subject
contract/lease, #C 14-2084 PW for an additional term. The contract renewal period
will be 9/30/14 to 9/30/15. Tne annual budgeted amount for this contract is $ 250,000.
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 REPRESENTATI AUTHORIZED COMPANY REPRESENTATIVE
Contractor:
S: [ow
Approved By 2 z LE Approved By: ult
| Ernie Padgett
Approved By: Title:_Vico “Pres dent
Charles K. Windes, Jr., Chairman
Date: Date: gol
County Department Instructions:
1) Obtain signatures from Department Director, authorized Company Representative and then
2)
3)
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).
Keep a copy of this form for your records.
Send original to Purchasing Services Coordinator.
If you have any questions please contact the Purchasing Director at 850-689-5960, Fax: 850-
689-5998.