HomeMy WebLinkAboutR 2018-251 HR - Select Physical TherapyDocuSign Envelope ID: EAE3745D -23C6- 4352- A3D7- 9903DCB5D084
ORANGE COUNTY --- DEPARTMENT USE ONLY
Department
Party/Vendor Name: Select Physical Therapy Holdings, Inc and Rehab Clinics, Inc. PartyNendor Contact Person:
Ryan Billheimer Contact Phone: 610- 992 -7218 Party/Vendor Address: 680 American Avenue, Suite 200 City
King of Prussia State: PA Zip: 19406 Department: Amount: $15,000 Purpose: To provide a functional
employment testing program Budget Code(s): 10250020/630000 Vendor # 65 t68 (N /A if new vendor) Vendor
is a BOCC consultant? Yes ❑ NoR Contract Type: (Check one) New Q Renewal ❑ Amendment ❑ Effective
Date July 1,_2018 Approved by Board Yes❑ No@f Agenda Date:
This agreement is approved as to tec` Docu °Signed ay: .
I7epartmentl7n °cetor's Signa #ure ba6�UN Date: 6/26/2018
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Information Technologies
(Applicable only to bar thvarelsgfm are 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
Risk Mana eg men
Date;
This agreement is approved for sufficienc-- - Qoeusigned ay: `- _' -rds, specifications, and requirements:
QUsa Lr,GrVln.t 6 6/29/2018
Office of the Risk Management Office Date:
7FDCF917E800498...
Financial Services
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control
Act; DocuSigned by:
A.I.
Office of the Chief Financial Officer
704E51S1ACC1469...
Legal Services
This agreement is approved as V ' Da Signed by:
l[vt.Az halt, T�s(h
Office of the County Attorney
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Clerk to the Board
Date: 6/26/2018
Date: 6/29/2018
Received for record retention:
All DocuSign contracts must be copied to Donna Lloyd upon completion @ Doiloydf &—orangecountync.eoy
The following signature block is for hard copies only and is not required for DocuSign contracts:
Office of the Clerk to the Board Date: