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Okaloosa County BOCC — May 6, 2014 — Final Invoice with cover sheet — reading text
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CONTRACT/LEASE
PAYMENT APPROVAL FORM
COMPLETE AND FORWARD TO THE NEXT DEPARTMENT
COMPLETED BY DEPARTMENT
DATE: 4/7/2014
VENDOR NAME: R&EFARMS VENDOR #: 20900749 }
CONTRACT/LEASE#: C09-1691-WS
TASK COUNTY/FEMA
VENDOR : BUDGET
ORDER # PROJECT # ACCOUNT # AMOUNT $
INVOICE # (If Applicable) (If Applicable) DEPARTMENT #
721 | 4101 534405 | 6,336.00
Pio |
CS T{OT I
TOTAL | $ 6,336.00
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APPROVED FOR PROGRESS PAYMENT (please sign, as applicable and date)
CONTRACTOR'S ENGINEER/ARCHITECT/PROJECT MANAGER: LLY DATE:
COUNTY SUPERVISOR/PROJECT MANAGER: ha) aL / dpe EN ALFURT) DATE: ¢/-¥-/
DEPARTMENT DIRECTOR: “4 | if “Ww A’ DATE: 2.6]
\o CR CONTRACTS & GRANT MANAGER: VME Az Al - Zz AZ v DATE: AF
COUNTY ADMINISTRATOR: DATE:
(Payments>S25,000.) —?
ran yt eA
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FINAL L PAY MENT YES ws __ Of "Yes", forward to Purchasing Services Coordinator for Close-Ont)
DATE = DP OO, PURCHASING DIRECTOR:
a 7 (Per Initial Agreement) j
DATE: © Ags LS CONTRACTS & GRANTS MANAGER: —- Zn
CF (All Contracts)
DATE: COUNTY ADMINISTRATOR APPROVAL:
(Per Initial Agreement)
DATE: BOARD APPROVAL:
(Per Initial Agreement)
COMPLETED BY FINANCE - ACCOUNTS PAYABLE ONLY
eiscanvean: (09 641 OS
DATE RECEIVED: dlistid SBI]
REVIEWED BY: 0) Tan al QA
R & E FARMS, LLC
Phone: (334)534-4810
Email: riven3828@gmail.com
625 Burnt Street
Black, AL 36314
Bill To: P. O.# Billing Date INVOICE #
Okaloosa County Board of 4/01/ 2014 721
County Commissioners
302 North Wilson St. #203
Crestview, FL 32536
QUANTITY DESCRIPTION RATE AMOUNT
Hauling&Land $14.75
Application of Residuals
34 loads @ 30 yd = 1020 yd
11 load @ 12 yd = 132 yd
Total yards = 1152 yds Land Application of $5.50 $6,336.00
Residuals
V
TOTAL
DUE $6,336.00