Okaloosa County BOCC — September 20, 2016 — CenturyLink C06-1421-IS FinalPayment

CONTRACT/LEASE PAYMENT APPROVAL FORM l— COMPLETE AND FORWARD TO THE NEXT DEPARTMENT ) Il || COMPLETED BY DEPAR NT DATE: 8/30/2016 VENDOR NAME: CenturyLink VENDOR #: 015765 CONTRACT/LEASE #: C06-1421-IS VENDOR TASK COUNTY/FEMA BUDGET ACCOUNT# | AMOUNT § INVOICE # ORDER # PROJECT # DEPARTMENT # (If Applicable) (If Applicable) 312332066 0114 541010 $13.926.72 08/25/16 TOTAL $13.926.72 VED FOR PAYMENT (please sign, as applicable and date CONTRACTOR’S ENGINEER/ARCHITECT/PROJECT MANAGER: DATE: COUNTY SUPERVISOR/PROJECT MANAGER: _/q ) Q_/Q DATE: & [ 20 / Lo [ DEPARTMENT DIRECTOR: Q,XL,\MLM _ b DATE: g’ 3 l l Q fé CONTRACTS & GRANTS MAN%ER: DATE: COUNTY ADMINISTRATOR: DATE: (Paymenis > $25,000,) L i FINAL PAYMENT FINAL PAYMENT YES &] NO E (If “Yes”, forward to Purchasing Services Coordinator for Close-Out) DATE: fl ! ]f};) & PURCHASING DIRECTOR: %A \IQD()\J,( m&k . (Per Inilial Agreement) bk) o (M DATE: / ’ CONTRACTS & GRANTS MANAGEK: (All Contracis) DATE: COUNTY ADMINISTRATOR APPROVAL: (Per Initial Agreement) DATE: BOARD APPROVAL: (Per Initial Agreement) flz...~,-.-. . . ]" COMPLETED BY FINANCE - ACCOUNTS PAYABLE ONLY FISCAL YEAR: DATE RECEIVED: REVIEWED BY: CONTRACT CLOSE-OUT CHECKLIST (To Be Prepared by the Purchasing Services Coordinator) DATE: September 13, 2016 TO: Contracts & Grants Manager, Finance Department Contracts & Grants Office SUBJECT: Contract No. C06-1421-1S MANAGING DEPARTMENT: IS CONTRACTOR'S NAME: CENTURY LINK PROJECT TITLE: TELEPHONE SERVICES The aftached has met the final payment contract requirement in subject contract. Yes No 1. Final Invoice X 2. Completed Contract/Lease Payment Approval Form ] X 3. Close-Out Documents Yes No N/A a. Signed Release of Lien Ol L] X b. Proof of Completion Advertisement [l Cl X c. Certificate of Insurance ] L] X d. Consent of Surety to Final Payment ] ] X e. Proof of Performance/Payment Bond O O X Continuation 12 Months Following Final Payment x 4. Agenda Request 5 Remarks (%MMJL Ut 16z Purclbgling Services Coordinator DATE Okaloosa County Information Technology Department Memo To: Purchasing/Contracts and Grants/Okaloosa County BCC From: Denise Broadway, IT Executive Assistant | cc: Dan Sambenedetto, IT Interim Director Date: September 13, 2016 Re: CenturyLink Contract #C06-1421-1S Please know that the original payment approval form for the final payment of CenturyLink contract #C06- 1421-IS is missing. The document was sent via courier interoffice to Purchasing on September 6, 2016 and was never received. Therefore, | request that you use the copy. Account Name: OKALOOSA CTY FLORIDA FINANCE D Account Number: 312332066 P.O. Box 1319 Page: 1 of 273 Chariotte, NC 28201-1319 Bill Date: Aug. 25,2016 16,823.61 13,767.59 CR 0.00 15,247.09 Payment Summary Previous Balance 16,823.681 Payment by check received on AUG 16 13,767.59 CR S Balance . 7 T 3bseez | Adjustments/Credits Summary Adjustments to Previous Balance 0.00 ; Total Adjustments. " TG 1 Current Charge Summary Monthly Charges 14,516.25 One-Time Charges 301.50 Usage Charges ) 26.39 Discount 0.00 Adjustments 89.78 CR Taxes, Fees, and Surcharges 492,73 Total Current Charges : 1524708 Due Date Sep. 15, 2016 Just a friendly reminder that your account is past due. If you have already made your payment, thank you for bringing your account up to date. Amount Due 18.303.11 ***PLEASE FOLD, TEAR HERE AND RETURN THIS PORTION WITH YOUR PAYMENT™ FOR CHANGE OF ADDRESS OR PAYMENT AUTHORIZATION: D D Please check here and complete reverse. Thank You. Account Number: 312332066 Amount Due By Sep. 15, 2016 18,303.11 CenturyLink OKALOOSA CTY FLORIDA FINANCE DEPT P.0. Box 1319 302 N WILSON ST Charlotte, NC 28201-1319 CRESTVIEW, FL 32536-3473 000031233206600000003056026000000000082516000183031151000000 P.O.Box 1319 Charlotte, NC 28201-1319 Account Name: OKALOOSA CTY FLORIDA FINANCE D Account Number: 312332066 Page: 2 of 273 Bill Date: Aug. 25, 2016 Important Notices and Information : Al