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Okaloosa County BOCC — September 16, 2014 — Southern Rock Lime — reading text
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CONTRACT/LEASE RENEWAL FORM
Date: August 18, 2014
Company Name: Southern Rock & Lime, Inc.
Atin: James Clemons
PO Box 297
Blountstown, Fl 32624
RE: C14-2108-PW
Dear Mr. Clemons:
The Okaloosa County Board of County Commissioners agrees to renew the subject
contract/lease, #C14-2108-PW for an additional term. The contract renewal period
will be 10/1/14 to 9/30/15. The annual budgeted amount for this contract is $250,000.
lf 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 REPRESENTATIVES- AUTHORIZED COMPANY REPRESENTATIVE
Dept. Directoy Y / | Contractor: Soc tons Lock x0, Mey LAC-
Approved hee Approved
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(as prescribed below on ite 1) NJ
Approved By: Title: Pion nlest
(as prescribed below on item 1)
Date: Date: Veh
County Department Instructions:
1) Obtain signatures from Department Director, authorized Company Representative and then
Purchasing Director <$25K and less, County Administrator <S50K and less or Board >S50K, as
necessary. If Board approval is required, the Chairman and County Administrator's signatures
are required. Make sure the company provides a current Cerificate of Insurance. (if
applicable).
2) Keep a copy of this form for your records.
3) Send original to Purchasing Services Coordinator.
If you have any questions please contact the Purchasing Director at 850-689-5960, Fax: 850-
689-5998.
