Okaloosa County BOCC — October 16, 2012 — Meridian Contract Extension

Board of County Commissioners Purchasing Department State of Florida November 7, 2012 CONTRACT RENEWAL FORM Meridian Community Services Group, Inc. Attn: Lisa A. Blair, President 1500 Mahan Drive Suite 150 Tallahassee, FL 32308 RE: Contract C11-1864-GM CDB-Only Program Admin Services Dear Ms. Blair: The Okaloosa County Growth Management Department wishes to renew contract C1i1-1864-GM for an additional term. The contract renewal period will be from November 2 _ to December 3 2012. If you are in agreement, please print and sign two (2) copies of this forms and return it, along with a current Certificate of Insurance listing Okaloosa County as co-insured to: Elliot Kampert, Growth Management Director 1804 Lewis Turner Blvd Ft Walton Beach, FL 32547. COUNTY REPRESENTATIVE AUTHOURIZED COMPANY REPRESENTATIVE Contractor: ___ Meridian Community Services [ L\VTL// Approved By: (D) Ur Ce / + Requesting Dept: __ Growth Management on Approved By: Print Name: Elliot L. Kampert Print Name: Lisa A. Blair Title: Director Title: _ President Date: ui lishe Date: (| | 7 | i 7 v i] T County Department Instructions: 1) Obtain signatures from Department Director and authorized Company Representative. 2) Make sure the company provides a current Certificate of Insurance. (If applicable) 3) Keep a copy of this form for your records. 4) Send original to; Jack Allen, Purchasing Services Manager. If you have any questions please contact Jack Allen at 850-689-5960, Fax-850-689-5998, e-mail: jallen@co.okaloosa.fl.us Approved by Board of Cogiity Commissioners: Date: Don R. Amunds, Chairman