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Florida Fish & Wildlife Conservation Commission Contract Routing Review Form <br />1. Contract Number: 00252 A -I <br />2. Contract Manager's Name & Telephone Number: Rosa Torres 617-9546 <br />3. Requestor: Rosa Torres <br />Date: 2/8/16 <br />Telephone #: 617-9546 <br />Division/Office: HGM <br />4. Financial <br />Non -Financial <br />5. Brief Project Title / Contract Description: <br />Indian River County Public Shooting Range Concessionaire <br />❑ Amendment, If so Amendment Number: ® Renewal, If so, Renewal Number: 1 <br />6. Current Contract Amount <br />Increase Amount <br />Decrease Amount <br />Revised Contract Amount <br />0.00 <br />50.00 <br />7. Contract Begin Date <br />Original End Date <br />Revised End Date <br />3/13/2001 <br />3/12/2016 <br />3/13/2026 <br />8. Contractor Name <br />Indian River County Board of County Comm. <br />10. Contractor's Contact Name <br />9. Contractor's Vendor/Tax ID it and <br />Sequence Number Is the vendor registered? (Y/N) <br />F596000674 <br />Seq. #:006 <br />®Yes ❑ No <br />If yes, attach screen print of registration <br />Contractor's Telephone # <br />Bill Debraal <br />772/226-1410 <br />12. FACTS Information Attached? <br />DYes ®No <br />11. Cost/Price Analysis Required? <br />❑Yes No /f yes. please attach. <br />13. Legal Review of Solicitation? <br />❑Yes - Reviewed by: <br />® No N/A Comments for "No" <br />14. Administrative Review <br />Please route to next approver upon completion of your review. <br />Approval/ Disapproval <br />COMMENTS <br />CONTRACT <br />Signature: ,,i�,er--.: aiittL.,% Date: rV/5//• <br />Name:` <br />EK;Prove - No Edits <br />❑Approve with Edits <br />['Disapprove <br />SECTION / SUBSECTION REVIEWER Required?(../N.„). <br />Signature: Date: <br />Name: <br />❑Approve - No Edits <br />❑Approve with Edits <br />❑Disapprove <br />i'--- <br />' <br />BUDGET REVIEWER Required? : <br />Signature: Date: <br />Name: <br />❑Approve - No Edits <br />❑Approve with Edits <br />❑Disapprove <br />DIVISIO ,(W : 01,,_ 4. <br />Signa . e: —� 1 ` Date: 1_,— IS. _ 1 1O <br />Name:QStit\..x._c_❑Disapprove <br />-No Edits <br />❑Approve with Edits <br />CONTRACTS OFFICE REVIEWER <br />Signature: Datc: <br />Name: <br />❑Approve- No Edits <br />❑Approve with Edits <br />❑Disapprove <br />CHIEF INFORMATION OFFICER Required? Y/N. <br />Signature: Date: <br />Name: <br />❑Approve -No Edits <br />❑Approve with Edits <br />❑Disapprove <br />LEGAL REVIEWER . <br />Signature: Date: Z /Z 3 / /6 <br />Name: <br />EA prove - No Edits <br />❑Approve with Edits <br />❑Disapprove <br />Return signed Contract/Grant Review Routing Forman <br />draft agreement to the above Contract Manager for edits and/or execution. <br />FWC-167 (Revised - 7/13) <br />