HomeMy WebLinkAboutR 2019-597 Human Resources - Select Physical Therapy work fitness testing DocuSign Envelope ID:00D05599-14C3-451 E-84B4-EDC8CADBDAFD
ORANGE COUNTY—DEPARTMENT USE ONLY
Department
Party/Vendor Name: Select Physical Therapy Holdings,Inc and Rehab_Clinics,Inc. Party/Vendor 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: 1$ 5,000 Purpose: To provide a functional
employment testing program Budget Code(s): 10250020/630000 Vendor#65168 (N/A if new vendor) Vendor
is a BOCC consultant? Yes ❑NoO Contract Type: (Check one)New Q Renewal❑ Amendment ❑ Effective
Date July 1,2019 Approved by Board Yes❑NoEf Agenda Date:
This agreement is approved as to tec O+cfNgnhW content:
�jV't,V�,�& �jm U,O�hme-W 8/27/2019
Department Director's Signature - sao Bate:
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 sufficient of � �11
yStandards,specifications,and requirements:
Office of the Risk Management Office Q�tSa V�t t{fb Date: 8/27/2019
7FDCF9176800498...
Financial Services
This instrument has been pre-audited in the manner required by the Dotal Government Budget and Fiscal Control
Act: DocuSigned by:
Office of the Chief Financial Officer Date: 8/27/2019
@59-89CC1b ...
Legal Services
This agreement is approved as to �M aaaufl sufficiency:
'� "�
Office of the County Attorney 1� Pate: 9/3/2019_
Clerk to the Board
Received for retard retention:
All DocuSign contracts must be copied to Donna Lloyd upon completion @ Dolloyd 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: