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Okaloosa County BOCC — August 6, 2013 — Executed Payment Approval form — reading text
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CONTRACT/LEASE
PAYMENT APPROVAL FORM
COMPLETE AND FORWARD TO THE NEXT DEPARTMENT
COMPLETED BY DEPARTMENT
DATE: 10/8/2013
VENDOR NAME: BURTON & ASSOCIATES VENDOR #: 012868
CONTRACT/LEASE#: C00-0443-WS
TASK COUNTY/FEMA
VENDOR BUDGET
INVOICE # ORDER # PROJECT # DEPARTMENT # | SCCOUNT# AMOUNTS
Cf Applicable) (if Applicable)
486 15 4101 531900 4,696.00
TOTAL
CONTRACTOR'S ENGINEER/ARCHITECT/PROJECT MANAGER:
COUNTY SUPERVISOR/PROJECT MANAGER: bn bn Opt Wis
$ 4,696.00 ¥
APPROVED FOR PROGRESS PAYMENT Wiease sign, as applicable and date)
DEPARTMENT DIRECTOR:
[ECONTRACTS & GRANT MANAGER:
(LY V/ fy
COUNTY ADMINISTRATOR:
(Payments> $25,000.)
Sa) Leal
DATE:
pate: /0/F (3
DATE:__{)/ g/ 20/73
DATE:
DATE:
FINAL PAYMENT
FINAL PAYMENT YES / xo __ df "Yes", forward to Purchasing Services Coordinator for Close-Out)
V/A
DATE: PURCHASING DIRECTOR:
(Per Initial Agreement)
DATE: (O- K-13 CONTRACTS & GRANTS MANAGER:
(All Contracts)
DATE: |0-$ -\D COUNTY ADMINISTRATOR APPROVAL:
(Per Initial Agreement)
DATE: BOARD APPROVAL:
(Per Initial Agreement)
COMPLETED BY FINANCE - ACCOUNTS PAYABLE ONLY
FISCAL YEAR:
DATE RECEIVED:
REVIEWED BY: