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Okaloosa County BOCC — September 3, 2013 — C. W. Roberts Final Payment — reading text
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CONTRACT/LEASE
PAYMENT APPROVAL FORM
COMPLETE AND FORWARD TO THE NEXT DEPARTMENT
COMPLETED BY DEPARTMENT
DATE: 10/9/2013
VENDOR C.W. Roberts Contracting Inc. VENDOR #: 20101504
CONTRACT/LEASE#: CO7-1453-PW 4
VENDOR TASK COUNTY/FEMA BUDGET
a sya ORDER # PROJECT # DEPARTMENT | ACCOUNT # AMOUNT $
INVOICE # . ;
(If Applicable) (Uf Applicable) #
48305 3202 4 563167 4,459.13
3202 563490 9,969.09
302 ZaQS1O000
Total 14,428.22
APPROVED FOR PROGRESS PAYMENT (please sign, as applicable and date)
CONTRACTOR'S ENGINEER/ARCHITECT/PROJECT MANAGER: DATE:
COUNTY SUPERVISOR/PROJECT MANAGER: fay Sinetensys DATE: LILI Ie
DEPARTMENT DIRECTOR: CO John Hotstad = DATE: Vi Mar A 3
CONTRACTS & GRANT MANAGER: G VA DATE:
COUNTY ADMINISTRATOR: DATE:
(Payments> $25,000.)
FINAL PAYMENT
—— A — (If "Yes", forward to Purchasing Services Coordinator for Close-Out)
DATE: PURCHASING DIRECTOR:
(Per Initial Agreement)
=|
DATE: CONTRACTS & GRANTS MANAGER:
(All Contracts)
DATE: COUNTY ADMINISTRATOR APPROVAL:
(Per Initial Agreement)
DATE: BOARD APPROVAL:
(Per Initial Agreement)
COMPLETED BY FINANCE - ACCOUNTS PAYABLE ONLY
FISCAL YEAR:
DATE RECEIVED:
REVIEWD BY: Z1EG
©
CONTRACTING, INC.
sey, SS, dip
C.W. Roberts Contracting, Inc.
P.O. Box 16279
Tallahassee, FL 32317 INVOICE: 48305
HOSFORD, FLA. 850-385-5060
FAX: 850-385-5420 PAGE: 4
DATE: 09/29/2013
ACCOUNT NO: 10396 TERMS: Net 30 Days
SOLD TO: Okaloosa County Board of Commi
1759 S Ferdon Blvd Order:
Crestview , FL 32536
Location: Freeport Asphalt Plant
Fee Tax
Ticket Date P.O. Product Qty Rate Amount Amount Amount Total
36093559 09/25/13 ° Q eee? Freeport 9.5MMSPwRap 21.53 69.50 1496.34 0.00 0.00 1,496.34
36093560 09/25/13 ° C of Freeport 9.5MM SP wWRap 21.61 69.50 1501.90 0.00 0.00 1,501.90
‘ee.
_ 36093561__ 09/25/13 * Freeport 9.5MM SP wRap 21.02 69.50 1460.89 0.00 0.00 1,460.89
36093607 09/26/13 ° Freeport 9.5MM SP wRap 21.42 69.50 1488.69 0.00 0.00 1,488.69
36093608 09/26/13 * Z Freeport 9.5MM SP wRap 21.80 69.50 1515.10 0.00 0.00 1,615.10
36093609 09/26/13 ° Q Freeport 9.5MM SP wRap 21.68 69.50 1506.76 0.00 0.00 1,506.76
36093610 09/26/13 \C oot " Freeport 9.5MM SP wiRap 20.67 69.50 1436.57 0.00 0.00 1,436.57
36093611 09/26/13 * Ne Freeport 9.5MM SP wiRap 18.39 69.50 1278.11 0.00 0.00 1,278.11
36093612 09/26/13 ° Freeport 9.5MMSPwRap 18.78 69.50 1305.21 0.00 0.00 1,305.21
36093613 09/26/13 ° Freeport 9.5MMSP wRap 20.70 69.50 1438.65 0.00 0.00 1,438.65
Subtotal 207.60 Ton $14,428.22 $0.00 $0.00 $14,428.22
Invoice Total 207.60 Ton $14,428.22 $0.00 $0.00 $14,428.22
Total Invoice ----- >
$14,428.22