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DocuSign Envelope ID:6EB7A98E-7386-481D-BB68-D6A5BBAODDCB <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Maxim Physician Resources, LLC Party/Vendor Contact Person: Laird Dunham Contact <br /> Phone: 972-729-2571 Party/Vendor Address: 5001 LBJ Freeway. Suite 900 City Dallas State: TX Zip: 75244 <br /> Department: Health Amount: $30.000 Purpose: Temp nurse staff services Budget Code(s): 10414020-630000 <br /> Vendor#N/A (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No[] Contract Type: (Check one) <br /> New ® Renewal ❑ Amendment ❑ Effective Date 5-23-16 Approved by Board Yes❑ No❑ Agenda <br /> Date: <br /> This agreement is approved as to to P,q1°ff did content: <br /> Department Director's Signature Date: <br /> 5/26/2016 <br /> Information Technolosies <br /> (Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is <br /> approved as to information technology content and specifications: <br /> Office of the Chief Information Officer Date: <br /> Risk Management <br /> This agreement is approved for sufficienc %WwRaystandards, specifications,and requirements: <br /> Q�Sa r,6�6 5/26/2016 <br /> Office of the Risk Management Officer ,FncE917unnags Date: <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control <br /> Act: DocuSigned by: <br /> Office of the Chief Financial Officer Date: 5/26/2016 <br /> Legal Services <br /> This agreement is approved as to(fug0Pf&WrWhd sufficiency: <br /> Office of the County Attorney 4,— Date: 5/27/2016 <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloydkorangecount.nic.gov <br /> The following signature block is for hard copies only and is not required for Docusign contracts: <br /> Office of the Clerk to the Board Date: <br /> Revised 1/16 <br /> 8 <br />