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EXHIBIT I
CONTRACT/LEASE
PAYMENT APPROVAL FORM
COMPLETE AND FORWARD TO THE NEXT APPROVING DEPARTMENT
COMPLETED BY DEPARTMENT
DATE: 1118/2013
VENDOR NAME: Gum Creek Farms, Inc. VENDOR #: 20401903
COUNTY AGREEMENT # (Contact Contract/Lease Coordinator, if unknown) C12-1974-PW
Old Antioch Road
VENDOR
INVOICE#
TASK
ORDER#
{if a~~Iicable}
COUNTY/FEMA
PROJECT#
{if a~~licable}
BUDGET
DEPARTMENT# ACCOH~T#
za'l, AMOUNT
;,qq_lq
5 - 0306 _____:3 'J,.O l 5<o34~ ~ !119..,t66.95
"bO~ ~05 1 100 .:l~ , 'll~ I Itt
TOTAL $54,106.95
APPROVED FOR PAYMENT (11./ease initia/1 as aeelicable and datel :
ENGINEERIARCHITECT/PROJECT MANAGER -pV DATE: ,I,Bl\~
COUNTY PROJECT MANAGER: Z)-7 DATE: 1/Jcll~
I I
DEPARTMENT HEAD: ~ DATE: c..f?//02/G
I
FINAL PAYMENT: YES ~0 D
CONTRACTS & GRANTS
DATE: _ _ __ CONTRACTS & GRANTS MANAGER :
DATE: _ _ __ COUN1Y ADMINISTRATOR APPROVAL: _ _ __ (Only Payments $25,001- $50,000)
FINAL PAYMENT APPROVAL (if needed) :
PURCHASING DIRECTOR: (Only Contracts < = $25,000)
COUNTY ADMINISTRATOR :
- - - - - - - (Only Contracts between $25,001 to $50,000)
Co11tracts Over $50,000- BCC Approved
COMPLETED BY FINANCE -ACCOUNTS PAYABLE ONLY
FISCAL YR: _ __
DATE RECEIVED: _ _ __