HomeMy WebLinkAboutR 2016-687-E Health - Maxim Healthcare Services for temp medical staff services DocuSign Envelope ID:3D2AE91 F-A053-456D-811 F-727562AB2926
ORANGE COUNTY—DEPARTMENT USE ONLY
Department
Party/Vendor Name: Maxim Heathcare Services Party/Vendor Contact Person: Scott Dannelley Contact Phone:
919-714-8623 Party/Vendor Address: 7227 Lee Deforest Drive City Columbia State: MD Zip: 21046
Department: Health Amount: $30,000 Purpose: Temp medical staff services Budget Code(s): 10414020-630000
Vendor#63832 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No® Contract Type: (Check one)
New ® Renewal ❑ Amendment ❑ Effective Date 11-21-16 Approved by Board Yes❑ No❑ Agenda
Date:
This agreement is approved as to to /f��,afuf&W find content:
1,0� 15 i 12/1/2016
Department Director's Signature Date:
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Information Technologies
(Applicable only to hardwarelsoftware purchases or related services)This agreement has been reviewed and is
approved as to information technology content and specifications:
Office of the Chief Information Officer Date:
Risk Management
This agreement is approved for sufficienc), gKwwwbbstandards,specifications, and requirements:
aUS& (hnut16 12/1/2016
Office of the Risk Management Officer 7FncFanFRnn4Qs Date:
Financial Services
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control
Act: DocuSigned by:
Office of the Chief Financial Officer Date: 12/1/2016
Legal Services
This agreement is approved as t 4 `'Md sufficiency:
I �Office of the County Attorney Date: 12/2/2016
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloydoran eg countync. og_v
The following signature block is for hard copies only and is not required for Docusign contracts:
Office of the Clerk to the Board Date:
Revised 1/16
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