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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
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Approved By: (D) Ur Ce / +
Requesting Dept: __ Growth Management
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Approved By:
Print Name: Elliot L. Kampert Print Name: Lisa A. Blair
Title: Director Title: _ President
Date: ui lishe Date: (| | 7 |
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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