READ ALONGSIDE THE SOURCE
Okaloosa County BOCC — September 16, 2014 — Contract lease Payment Approval Form — reading text
Part 1 of 1. These parts divide the reading text for browsing; they are not the source document's page numbers.
Machine-extracted text — 133-Contract lease Payment Approval Form.pdf
Machine-extracted OCR text · Review label: Machine produced / unreviewed
Compare this copy with the preserved source. Review labels describe the recorded status of this file; they do not guarantee that the text is error-free. Spacing and line breaks are retained, with long lines wrapped to fit the screen.
CONTRACT/LEASE
PAYMENT APPROVAL FORM
COMPLETE AND FORWARD TO THE NEXT DEPARTMENT
|E= ee ——<——— —— ————— = =——|
COMPLETED BY DEPARTMENT
DATE: 9/8/2014
VENDOR NAME: _Intermedix/Advanced Data Processing, Inc. VENDOR #: 015407
CONTRACT/LEASE#: C99-0257-PS
TASK COUNTY/FEMA
VENDOR BUDGET
MOUNT
INVOICE # ORDER # PROJECT# — | nepartments¢| ACCOUNT# AMOUNTS
(if Applicable) (If Applicable) .
INVADPI14484- 4500 534206 $ 30,860.63
YE YF | |
Ale p4
fue TOTAL | $ 30,860.63
APPROVED FOR PROGRESS PAYMENT (please sign, as applicable and date)
CONTRACTOR'S ENGINEER/ARCHITECT/PROJECT MANAGER: . DATE:
fj
COUNTY SUPERVISOR/PROJECT MANAGER: —Y ZZ DATE:
DEPARTMENT DIRECTOR: 435 ZL DATE: YL. 19, Nd SF
i Villani, Public Safety Director
x CONTRACTS & GRANT MANAGER: DATE:
COUNTY ADMINISTRATOR: DATE:
(Payments $25,000.)
———
FINAL PAYMENT
FINAL PAYMENT YES_X_ NO (f "Yes", forward to Purchasing Services Coordinator for Close-Out)
DATE: 4) g | l¢ PURCHASING DIRECTOR: One colrwk Zan dorcel
(Per Initial Agreement)
U)
yt pate: GY-%-Z0/ Y CONTRACTS & GRANTS MANAGER: Nts Vio Sore —
(All Contracts)
DATE: 4 yo | Iyp COUNTY ADMINISTRATOR arreovpie Sipps ;
(Per Initial Agreement)
DATE: BOARD APPROVAL:
Le
UV
(Per Initial Agreement)
COMPLETED BY FINANCE - ACCOUNTS PAYABLE ONLY
FISCAL YEAR:
DATE RECEIVED:
REVIEWED BY: