Orange County NC Website
Browse       Search
DocuSign Envelope ID: EAE3745D -23C6- 4352- A3D7- 9903DCB5D084 <br />ORANGE COUNTY --- DEPARTMENT USE ONLY <br />Department <br />Party/Vendor Name: Select Physical Therapy Holdings, Inc and Rehab Clinics, Inc. PartyNendor Contact Person: <br />Ryan Billheimer Contact Phone: 610- 992 -7218 Party/Vendor Address: 680 American Avenue, Suite 200 City <br />King of Prussia State: PA Zip: 19406 Department: Amount: $15,000 Purpose: To provide a functional <br />employment testing program Budget Code(s): 10250020/630000 Vendor # 65 t68 (N /A if new vendor) Vendor <br />is a BOCC consultant? Yes ❑ NoR Contract Type: (Check one) New Q Renewal ❑ Amendment ❑ Effective <br />Date July 1,_2018 Approved by Board Yes❑ No@f Agenda Date: <br />This agreement is approved as to tec` Docu °Signed ay: . <br />I7epartmentl7n °cetor's Signa #ure ba6�UN Date: 6/26/2018 <br />6IC98D269FO149F... <br />Information Technologies <br />(Applicable only to bar thvarelsgfm are 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 <br />Risk Mana eg men <br />Date; <br />This agreement is approved for sufficienc-- - Qoeusigned ay: `- _' -rds, specifications, and requirements: <br />QUsa Lr,GrVln.t 6 6/29/2018 <br />Office of the Risk Management Office Date: <br />7FDCF917E800498... <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 />A.I. <br />Office of the Chief Financial Officer <br />704E51S1ACC1469... <br />Legal Services <br />This agreement is approved as V ' Da Signed by: <br />l[vt.Az halt, T�s(h <br />Office of the County Attorney <br />fl79A4D525COF4FD... <br />Clerk to the Board <br />Date: 6/26/2018 <br />Date: 6/29/2018 <br />Received for record retention: <br />All DocuSign contracts must be copied to Donna Lloyd upon completion @ Doiloydf &—orangecountync.eoy <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 />