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Okaloosa County BOCC — March 18, 2014 — Corizon — reading text
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CONTRACT/LEASE
PAYMENT APPROVAL FORM
COMPLETE AND FORWARD TO THE NEXT DEPARTMENT
IE EE = =]
COMPLETED BY DEPARTMENT
pate: 03/11/2014
VENDOR NAME: CORIZON VENDOR #: 21200124
CONTRACT/LEASE#: C10-1816-COR
TASK COUNTY/FEMA
VENDOR BUDGET
ORDER # PROJECT # ACCOUNT # AMOUNT $
INVOICE # ORDERS Rosey DEPARTMENT #
CZN000014508 07126 531230 $ 386,863.79
TOTAL $ 386,863.79
APPROVED FOR PROGRESS PAYMENT (lease sign, as applicable and date)
CONTRACTOR'S ENGINEER/ARCHITECT/PROJECT MANAGER: DATE:
re (Rogers) pate: .3/1//)
VA
COUNTY SUPERVISOR/PROJECT
DEPARTMENT DIRECTOR: (Lawson) pate: 7/#///%
(Y CONTRACTS & GRANT MANAGER: DATE: ’
COUNTY ADMINISTRATOR: DATE:
(Payments> $25,000.)
E
FINAL PAYMENT
FINAL PAYMENT ves\¥ lvol_| (if "Yes", forward to Purchasing Services Coordinator for Close-Out)
DATE: PURCHASING DIRECTOR:
(Per Initial Agreement)
at 64 DATE: .45-/2-20/ Y CONTRACTS & GRANTS MANAGER: SG sry
(All Contracts)
DATE: gp /i a COUNTY ADMINISTRATOR APPROVAL: Ss
(Per Initial Agreement) od
DATE: BOARD APPROVAL:
(Per Initial Agreement)
COMPLETED BY FINANCE - ACCOUNTS PAYABLE ONLY
FISCAL YEAR:
DATE RECEIVED:
REVIEWD BY: