2016-687-E Health - Maxim Healthcare Services for temp medical staff services

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DocuSign Envelope ID:3D2AE91 F-A053-456D-811 F-727562AB2926 ORANGE COUNTY-DEPARTMENT USE ONLY Department 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: $30,000 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 11-21-16 Approved by Board Yes No❑ Agenda Date: This agreement is approved as to to /f gal nqf Jed content: Cl f2 t 12/1/2016 Department Director's Signature Date: -e9EDSDa C60545E 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 sufficiency iion'standards,specifications, and requirements: aMMS& rbv/Lato 12/1/2016 Office of the Risk Management Officer 7ED.CF9176RUO49R Date: 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 0,4 Date: 12/1/2016 7D4C5161k =o°... Legal Services This agreement is approved as torlVdffeAffiddifd sufficiency: 12/2/2016 Office of the County Attorney`-4 C06?94CA4Ag.. Date: Clerk to the Board Received for record 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: Revised 1/16 8