R 2017-632-E Finance - MAXIMUS - Consultant for Cost Allocation Plan, EMS Medicaid Cost Report

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DocuSign Envelope ID:54B16D7E-C063-4FF1-B6ED-4F40C221096B ORANGE COUNTY-DEPARTMENT USE ONLY Department Party/Vendor Name: MAXIMUS Consulting Services Inc. Party/Vendor Contact Person: Jason Jennings Contact Phone: 804-323-3535 Party/Vendor Address: 808 Moorefield Park Drive, Suite A, Richmond, VA, 23236 Department: Finance & Administrative Services Amount: $27,900 ($8,300 Cost Plan (FY2017, FY2018, FY2019 and$1,000 EMS Report (FY2017, FY 2018,FY2019)))Purpose: Consultant for Cost Allocation Plan and EMS Medicaid Cost Report over the next 3 fiscal years Contract Budget Code(s): 10230020 630000—Finance and Administrative Services Contract Services Vendor# (N/A if new vendor): 5730 Vendor is a BOCC consultant? Yes ❑No Contract Type: (Check one)New® Renewal ❑ Amendment ❑ Effective Date:N/A Approved by Board: Yes No Agenda Date: N/A This agreement is approved as to technical f rm` t 6t�'rit: 0,44. 1.00x. 10/31/2017 Department Director's Signature m481ACC14n9 Date: 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 Director of Information Technology Date: Risk Management This agreement is approved for sufficiency -:saw standards,specifications, and requirements: M rbvvutl6 11/15/2017 Office of Risk Management Rsa�6a0e49a 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 7D �� 10/31/2017 7DaE5�81 ACC�aQ9 Date: Legal Services This agreement is approved as to legal form Re i gty: joLvi, t°blit,viS 11/22/2017 Office of the County Attorney EaAaa : ., Clerk to the Board Received for record retention: Office of the Clerk to the Board Date: