HomeMy WebLinkAboutR 2019-351 Health - Maxim Healthcare Services temporary services DocuSign Envelope ID: D6ED5842-3296-4CBF-953B-BD73BFOOC8D1
ORANGE COUNTY-DEPARTMENT USE ONLY
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: $25,000 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 6-20-19 Approved by Board Yes❑ No❑ Agenda
Date:
This agreement is approved as to technical form and content and I as Department Director affirmatively state work
on this project has not been initiated prior to execution of the agreement:
DocuSigned by:
S&Wof 6/19/2019
Department Director's Signature sCisFzoosEsa45F. Date:
Agreements for emergency services or repair are not subject to the above affirmation. If services related to this
agreement have already begun or been completed please briefly describe the nature of the emergency condition that
was addressed:
Information Technologies
(Applicable only to hardware/software 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 -oocuSig/Pn�ed by: rds,specifications,and requirements:
Office of the Risk Management Officer 7��tsa' �,oVln.��b FDCF91768004M. Date: 6/20/2019
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: 6/21/2019
704E59S1ACC1409.
Legal Services
This agreement is approved as t DocuSigned by:
9WAk hakit, I-6W 6/21/2019
Office of the County Attorney_ 079MD525COF4Fa. Date:
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Sherri Ingersoll upon completion: singersoll@orangecountync.gov
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 12/18
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