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Okaloosa County BOCC — November 5, 2013 — Contact Payment Form — reading text
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CONTRACT/LEASE
PAYMENT APPROVAL FORM
= = 1]
COMPLETED BY DEPARTMENT
DATE: = 12/17/13
VENDOR NAME: Pictometry International Corp. VENDOR #:
CONTRACT/LEASE #: C13-2015-IS
VENDOR TASK COUNTY/FEMA BUDGET ACCOUNT # AMOUNT $
INVOICE # ORDER # PROJECT # DEPARTMENT #
(ff Applicable) (If Applicable)
INV011247 01112 534105 $45,524.00
09/23/13
TOTAL $45,524.00
APPROVED FOR PROGRESS PAYMENT (please sign, as applicable and date)
CONTRACTOR’S ENGINEER/ARCHITECT/PROJECT TER: A DATE:
COUNTY ee. I . Cc DATE: bz G I Zh (3
DEPARTMENT DIRECTOR: _{2#Z~ CZ DATE: /A / /¢ i 3
CONTRACTS & GRANTS MANAGER: DATE:
COUNTY ADMINISTRATOR: DATE:
(Payments > $25,000.)
FINAL PAYMENT
FINAL PAYMENT YES NO [| (if “Yes”, forward to Purchasing Services Coordinator for Close-Out)
DATE: PURCHASING DIRECTOR:
(Per Initial Agreement) xy
DATE: WAS CONTRACTS & GRANTS MANAGER: (S wudle_ ( KK Ashe fan
(All Contracts) ; y _)
DATE: COUNTY ADMINISTRATOR APPROVAL:
(Per Initial Agreement)
DATE: BOARD APPROVAL:
(Per Initial Agreemeni)
lf — —_—_ = = ———
COMPLETED BY FINANCE - ACCOUNTS PAYABLE ONLY
FISCAL YEAR:
DATE RECEIVED:
REVIEWED BY:
Po