HomeMy WebLinkAboutR 2011-034 Finance - Maximus Consulting Services EMS cost report ORANGE COUNTY—CONTRACT CONTROL SHEET
Routing Order: (1)Department,(2)IT, (3)Risk Management,(4)Financial Services,(5)Attorney,(6)Manager, (7)Clerk
This Document shall accompany all contracts and shall be submitted for signature in the Routing Order specified above. If the Manager
determines the contract is not appropriate for Manager approval the Manager shall submit the contract for BOCC approval. Contracts for
BOCC approval must be submitted through, and complete,the routing process prior to agenda review. Contracts for legal review should
be completed through the legal review process prior to being routed for signature.
Department
Party/Vendor Name: Maximus Consulting Services,Inc. Party/Vendor Contact Person: Jason Jennings Contact Phone: 804.323.3535
ext. 20 Party/Vendor Address: 804 Moorefield Park Drive, Suite 101 City Richmond, State:Va Zip: 23236 Department:
Amount: 700 Purpose:EMS Cost Report Budget Code(s): 10230020-630000 Vendor# 125825 (N/A if new vendor) Vendor is a
BOCC consultant? Yes ❑No® Contract Type: (Check one)New❑ Renewal® Amendment ❑ Effective Date 1-5-2011
Approved by Board Yes❑No® Agenda Date: Title of Contract: EMS Cost Report
If this is a Grant Agreement,pre-application has been approved by the Board of Commissioners Yes❑No®. If submitted for bid were
bids/RFPs received Yes❑No❑ Bid/RFP number This contract has been reviewed and approved by the Department Director as to
technical content:
1�
Department Director's Signature: ����"� ,� A114— Date: I l
IT Director
(Applicable only to hardware/software purchases or related services)This contract has been reviewed and approved by the Information
Technology Director as to technical content and information technology specifications:
IT Director's Signature: Date:
Risk Management
Include the following coverages: ❑ CGL; ❑ Auto; ❑ WC; 2 Professional; ❑ Property; ❑ OR No Insurance Required ❑. Hold
Contract pending receipt of Certificate of Insurance ❑. With incorporation of Insurance provisions as shown, this contract is approved
by the Risk Manager:
Risk Manager's Signature: Date: v2
"C"1 214111 2Origino,S
Financial Services
This Contract is conditioned upon appropriation by the Board of Commissioners Yes❑No®. A budget amendment is necessary
before approval Yes❑ No®. If budget amendment is necessary,please attach to this form. This instrument has been pre-audited in the
manner required by the Local Government Budget and Fiscal Control Act:
l` ."� 'r . /< Date: 2- I1
Financial Services Director's Signature: t-t" I/
County Attorney
Approval by Board ❑ (Contracts over $90,000.00 for goods or services, $250,000.00 for construction, or any BOCC consultant
contract). Approval by Manager.-❑ (All other contracts). This contract has been reviewed and approved by the Attorney as to legal
form and sufficiency:
g
Attorney's Signature - Date:
County Manager
This contract has been reviewed and is approved by the County Manager Yes❑No[].
This contract has been reviewed and is to be submitted for BOCC cof sideration Yes❑No❑.
Manager's Signature: Date: z
Clerk to the Board
Approved by BOCC on the day of ,20 Submitted for Chair signature on t e day of ,20
Clerk's Signature: rt `' !'r .J Dater of
Revised April 2010