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Board of County Commissioners
Purchasing Department
State of Florida
November 28, 2012
CONTRACT RENEWAL FORM
Matrix Design Group, Inc.
Attn: Celeste Werner
2224 W. Northern Avenue, Suite D240
Phoenix, AZ 85021
RE: Contract C11-1860-GM JLUS Small Area Study
Dear Ms. Werner:
The Okaloosa County Growth Management Department wishes to renew contract C11-1860-GM for
an additional term. The contract renewal period will be from October 31 to December 31_,
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
Requesting Dept: __ Growth Management ‘ Contract Metrix Design Group /
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Approved By: lh { Ap BA \/ LL ki Lt
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Print Name: _ Elliot L. Kampert Print Namé: celeste Boccieri Werner
Title: Director Title: __ Vice President
Date: n/a 2/20 VR Date: \\ Jas/aoia
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 County Commissioners:
Date: Don R. Amunds, Chair