PO_Johnson DavisI n1
, yo6 CITY OF OKEECHOBEE Fy - 3 PURCHASE ORDER
55 SE 3rd Avenue
,,( OkeechobeeOkeechobee,FL 34974 --...____�
FLORIDA•F,..,19I5
PO Number: 153 Date: 07/31/2023
Requisition #: 153 Vendor#: ohnson-Davis
ISSUED TO: Johnson-Davis Inc SHIP TO: City of Okeechobee, FL-General Services
604 Hillbrath Drive Attn:Patty Burnette
Lantana, FL 33462- 55 SE 3rd Avenue
Okeechobee, FL 34974
ITEM UNITS DESCRIPTION GL ACCT# PROJ ACCT# PRICE AMOUNT
1 0 PO 153-SE 4th Street Drainage Improv Project 3021131.a964 tr 0.00 218,500.00
O .-A75Q—Lo3O0
';'
�' SUBTOTAL: 218,500.00
^1 'X . TOTAL TAX: 0.00
Authorized by: . '` /,,,/'.;, \>
/ SHIPPING: 0.00/
TOTAL 218,500.00
1. Original invoice with remittance slip must be sent to:City of Okeechobee,55 SE 3rd Avenue,Okeechobee,FL 34974.
2. Payment may be expected within 30 days of receipt of goods and invoice.
3. C.O.D.shipment will not be accepted.
4. Purchase Order numbers must appear on all shipping containers,packing slips and invoices.Failure to comply with the above request may delay payment.
5. All goods are to be shipped F.O.B.Destination unless otherwise stated.
6. All materials and services are subject to approval based on the description on the face of the purchase order or appendages thereof.Substitutions are not permitted without
approval of the Requesting Department.Material not approved will be returned at no cost to the City.
7. Vendor or manufacturer bears risk of loss or damage until property received and/or installed.
8. The City is exempt from all federal excise tax-ID#59-6000393 and state tax—ID#85-8012621656C-6
4:ity CITY OF OKEECHOBEE PURCHASE ORDER
4 55 SE 3rd Avenue
Okeechobee, FL 34974
PO Number: 153 Date: 07/31/2023
Requisition #: 153 Vendor#: ohnson-Davis
ISSUED TO: Johnson-Davis Inc SHIP TO: City of Okeechobee, FL-General Services
604 Hillbrath Drive Attn:Patty Burnette
Lantana, FL 33462- 55 SE 3rd Avenue
Okeechobee, FL 34974
ITEM UNITS DESCRIPTION GL ACCT# PRO.]ACCT# PRICE AMOUNT
1 0 PO 153-SE 4th Street Drainage Improv Project 302-331.3904.000 0.00 218,500.00
SUBTOTAL: 218,500.00
Authorized by: , TOTAL TAX: 0.00
SHIPPING: O.00
TOTAL 218,500.00
1. Original invoice with remittance slip must be sent to:City of Okeechobee,55 SE 3rd Avenue,Okeechobee,FL 34974.
2. Payment may be expected within 30 days of receipt of goods and invoice.
3. C.O.D.shipment will not be accepted.
4. Purchase Order numbers must appear on all shipping containers,packing slips and invoices.Failure to comply with the above request may delay payment.
5. All goods are to be shipped F.O.B.Destination unless otherwise stated.
6. All materials and services are subject to approval based on the description on the face of the purchase order or appendages thereof.Substitutions are not permitted without
approval of the Requesting Department.Material not approved will be returned at no cost to the City.
7. Vendor or manufacturer bears risk of loss or damage until property received and/or installed.
8. The City is exempt from all federal excise tax-ID#59-6000393 and state tax—ID#85-8012621656C-6
oM o74;FC� Req. No. 17205
PURCHASE REQUISITION
Alth .,, � CITY OF OKEECHOBEE Important: This number must
55 S.E. Third Avenue be shown on all invoices,
,. - Okeechobee, FL 34974-2903 packages, cases, tickets and
y3 di Tel: 863-763-3372 correspondence.
Fax: 863-763-1686
Johnson-Davis Incorporated SHIP TO:
604 Hillbrath Drive City of Okeechobee
Lantana, FL 33462 � v 55 SE Third Avenue
FINANCE.: Okeechobee, FL 34974
28-23
INVOICE IN DUPLICATE:
THIS ORDER SUBJECT TO CONDITIONS ON FACE.
NO CHANGES MAY BE MADE WITHOUT WRITTEN
PERMISSION OF PROCUREMENT MANAGEMENT.
DATE VENDOR NO. DELIVERY DATE SHIP BEST F.O.B. DEST. TERMS
07/19/23 N/A N/A N/A N/A NET 30
ITEM NO ACCT. NUMBER QTY UNIT DESCRIPTION AMOUNT
1 302-331.3904 PW 04-10-05-23 City of Okeechobee $190,000.00
SE 4th Street Drainage Improvements
Project.
Awarded by City Council on 7/18/23
Drawdowns
15% contingency for potential addtl $28,500.00
concrete around the hydrodynamic
separator
TOTAL $218,500.00
CITY OF OKEECHOBEE IS EXEMPT FROM FEDERAL EXCISE AND TRANSPORTATION
TAXES AND STATE SALES TAX. DO NOT INCLUDE THESE TAXES IN YOUR INVOICE.
EXEMPTION CERTIFICATE WILL BE SIGNED UPON REQUIEST.
STATE SALES TAX EXEMPTION NO.85-8012621656C-6
FEDERAL I.D. NO 59-6000-393
AUTHORIZED SIGNATURE
RECEIVING RECORD
❑ PARTIAL X FINAL
-t City of Okeechobee
- Checklist for Purchase Requisitions/Purchase Orders
-
Today's Date:
7- q-a3
Vendor j Originating Department
— uc J It^COf Administration
tt n,, Co.ynif,. Hi ro D ifL _Finance
LQ Mrwa, 3 gqi Clerk
X General Services
Police
_Fire
Public Works
Section I.
Please mark each item YES or NO to determine if the checklist of minimum requirements for an item and/or
service is needed for your department prior to ordering/purchasing the item/service. If the answer is YES to
any of the below,please include the items listed in Section II.
YES NO
` A. Is it a professional service?
k
"` B. Is the vendor coming on city property other than delivering an item(s)?
?C C. Is it a contract for services?
✓( D. Is the product or service more than City Administrator's approval limits($14,999)?
Section II.
Please mark all items included:
YES NO
A. Approved signed contract by all parties
B. Provide all quotes for item/service
1 C. Current BTR with the City of Okeechobee if for services
0( D. Certificate of Insurance with requirements as previously indicated in the contract for services
E. W-9 if new Vendor
KF.Provide Bond if required
G. If Council approval is required,minutes must be provided. If minutes are not available at time
• of submittal,the Department Head and City Administrator will certify Council approval and the
agenda and item must be attached. (Minutes need to be provided when available)
Minutes provided Wit 1 Peallreit c a p►,t o f 7l g 12.5 CC O I 011ell
4( Required Certification ctv4331,0
Council
Approval Department Si t City A ministrator ' nature
Date
7184
to s' ed C ,��jro ate s ed /0�
SANDIA\Office Forrn�s'PProc�edures\Checklist 3 j Revised date 2022 10 12
CITY OF OKEECHOBEE
PURCHASE ORDER
55 SE 3rd Avenue
,Okeechobee Okeechobee,FL 34974
RAa3A.ims;d l tli
PO Number: 153 Date: 07/31/2023
Requisition#: 153 Vendor#: 1ohnson-Davis
ISSUED TO: Johnson-Davis Inc SHIP TO: City of Okeechobee, FL-General Services
604 Hillbrath Drive Attn:Patty Burnette
Lantana,FL 33462- 55 SE 3rd Avenue
Okeechobee,FL 34974
ITEM Utel0 SC HPTjON GL ACCT d JJ tT it "X ' `
1 0 P0153-SE 4th Street Drainage ImprovProject 302-33 4.000 0.00 218,500.00
3 0,2 e-3b-b
goy 2("3 -Ov
6712,1 /
„//q
SUBTOTAL: 21 ,500.00
Authorized by: �, TOTAL TAX; 0.00
SHIPPING: 0.00
TOTAL 218,500.00
1.Original invoice with remittance slip must be sent to:City of Okeechobee,55 SE 3rd Avenue,Okeechobee,FL 34974.
2. Payment may be expected within 30 days of receipt of goods and invoice.
3.CA,D.shipment will not be accepted.
4. Purchase Order numbers must appear on ail shipping containers,packing slips and Invoices.Failure to comply with the above request may delay payment.
5.Ail goods are to be shipped F.O.B.Destination unless otherwise stated.
6.All materials and services are subject to approval based on the description on the face of the purchase order or appendages thereof.Substitutions are not permitted without
approval of the Requesting Department.Material not approved will be returned at no cost to the City.
7. Vendor or manufacturer bears risk of loss or damage until property received and/or Installed.
8. The City Is exempt from all federal excise tax-IDp 59-6000393 and state tax—IDa 85-80126 216 56C-6
Payment View Drill Down — ❑ X
Close Form irp Print Screen A Help Q Documenjs(1)- l< < > •
Vendor Name: Johnson-Davis Inc Remittance Address: 604 Hiilbrath Drive
Lantana.FL 33462
Vendor Number: Johnson-Davis
U.S.A
Payment Number: 1415
General Payment Date 1/12/2024 Payment Amount S190.000.00
Payables
Payment Type Check
Distribution
AP Automation Packet APPKTOOS31 -1/12/24 Payables Total Payment S190.000.00
Documents
Bank Transaction Information
Bank Account 1000000433820 CDBG Grant Funds
Cash Account 302-101.2100 CASH IN BANK-SUNTRUST
Status Outstanding
Clear Date
Statement Date