Okaloosa County BOCC — February 16, 2016 — Horizons Closeout

CONTRACT CLOSE-OUT CHECKLIST (To Be Prepared by the Contracts and Lease Coordinator) DATE: 02/04/2016 TO: Contracis & Grants Manager, Finance Department Confracts & Grants Office SUBJECT: Contract No. C08-1592-TDC MANAGING DEPARTMENT: TDC CONTRACTOR'S NAME: HORIZONS OF OKALOOSA COUNTY PROJECT TITLE: PARKS BATHROOM CLEANING The attached 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 ] ] b. Proof of Completion Advertisement ] ] X c. Cerfificate of Insurance ] | X d. Consent of Surety fo Final Payment ] ] e. Proof of Performance/Payment Bond ] ] X Continuation 12 Months Following Final Payment Yes No 4. Agenda Request X ] 5 Remarks 02/04/2016 Contracts and Lease Coordinok)_r DATE CONTRACT/LEASE PAYMENT APPROVAL FORM COMPLETE AND FORWARD TO THE NEXT DEPARTMENT e —————— COMPLETED BY DEPARTMENT DATE: 01/25/16 VENDOR NAME: Horizons of Okaloosa County VENDOR #: 000428 CONTRACT/LEASE # C08-1592-TDC VENDOR TASK COUNTY/FEMA BUDGET ACCOUNT # | AMOUNT $ INVOICE# ORDER # PROJECT # DEPARTMENT # (If Applicable) (If Applicable) 121601 ~ 175~ 534010 7 $4,500.00 ~ Dec-15 7 TOTAL $4,500.00 APPROVED FOR PROGRESS PAYMENT (Please sign as applicable and date) CONTRACTOR'S ENGINEER/ARCHITEC'I‘/PROJE'%AGER: B o | DATE: COUNTY SUPERVISOR/PROJECT MANAGERZ 777~ M2/201 DATE: oy, DEPARTMENT DIRECTOR: o7 DATE: /, /¢ < il 4 CONTRACTS & GRANTS MANAGER: DATE: COUNTY ADMINISTRATOR: DATE: Payments>$25,000.) FINAL PAYMENT FINAL PAYMENT YES X NO (If "Yes", forward to Purchasing Services Coordinator for Close-Out) DATE: ZZA—_—' \ ((2 PURCHASING DIRECTOR (Per Initial Agreement) ATE:VZ f—é / é CONTRACTS & GRANTS MANAGER (All Contracts) DATE: 9{ //( /é COUNTY ADMINISTATOR APPROVAL (Per Initial Agreement) BOARD APPROVAL (Per Initial Agreement) ol 22424 M«/é%/ (74 =54 DATE: COMPLETED BY FINANCE - ACCOUNTS PAYABLE ONLY FISCAL YEAR: DATE RECEIVED: REVIEWED BY: