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DocuSign Envelope ID: D6ED5842-3296-4CBF-953B-BD73BFOOC8D1 <br /> ORANGE COUNTY-DEPARTMENT USE ONLY <br /> Party/Vendor Name: Maxim Heathcare Services Party/Vendor Contact Person: Scott Dannelley Contact Phone: <br /> 919-714-8623 Party/Vendor Address: 7227 Lee Deforest Drive City Columbia State: MD Zip: 21046 <br /> Department: Health Amount: $25,000 Purpose: Temp medical staff services Budget Code(s): 10414020-630000 <br /> Vendor#63832 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No® Contract Type: (Check one) <br /> New ® Renewal ❑ Amendment ❑ Effective Date 6-20-19 Approved by Board Yes❑ No❑ Agenda <br /> Date: <br /> This agreement is approved as to technical form and content and I as Department Director affirmatively state work <br /> on this project has not been initiated prior to execution of the agreement: <br /> DocuSigned by: <br /> S&Wof 6/19/2019 <br /> Department Director's Signature sCisFzoosEsa45F. Date: <br /> Agreements for emergency services or repair are not subject to the above affirmation. If services related to this <br /> agreement have already begun or been completed please briefly describe the nature of the emergency condition that <br /> was addressed: <br /> Information Technologies <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 -oocuSig/Pn�ed by: rds,specifications,and requirements: <br /> Office of the Risk Management Officer 7��tsa' �,oVln.��b FDCF91768004M. Date: 6/20/2019 <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: 6/21/2019 <br /> 704E59S1ACC1409. <br /> Legal Services <br /> This agreement is approved as t DocuSigned by: <br /> 9WAk hakit, I-6W 6/21/2019 <br /> Office of the County Attorney_ 079MD525COF4Fa. Date: <br /> Clerk to the Board <br /> Received for record retention: <br /> All Docusign contracts must be copied to Sherri Ingersoll upon completion: singersoll@orangecountync.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 12/18 <br /> 8 <br />