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DocuSign Envelope ID:00D05599-14C3-451 E-84B4-EDC8CADBDAFD <br /> ORANGE COUNTY—DEPARTMENT USE ONLY <br /> Department <br /> Party/Vendor Name: Select Physical Therapy Holdings,Inc and Rehab_Clinics,Inc. Party/Vendor 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: 1$ 5,000 Purpose: To provide a functional <br /> employment testing program Budget Code(s): 10250020/630000 Vendor#65168 (N/A if new vendor) Vendor <br /> is a BOCC consultant? Yes ❑NoO Contract Type: (Check one)New Q Renewal❑ Amendment ❑ Effective <br /> Date July 1,2019 Approved by Board Yes❑NoEf Agenda Date: <br /> This agreement is approved as to tec O+cfNgnhW content: <br /> �jV't,V�,�& �jm U,O�hme-W 8/27/2019 <br /> Department Director's Signature - sao Bate: <br /> Information Technologies <br /> (Applicable only to hardwarelsoftware 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 sufficient of � �11 <br /> yStandards,specifications,and requirements: <br /> Office of the Risk Management Office Q�tSa V�t t{fb Date: 8/27/2019 <br /> 7FDCF9176800498... <br /> Financial Services <br /> This instrument has been pre-audited in the manner required by the Dotal Government Budget and Fiscal Control <br /> Act: DocuSigned by: <br /> Office of the Chief Financial Officer Date: 8/27/2019 <br /> @59-89CC1b ... <br /> Legal Services <br /> This agreement is approved as to �M aaaufl sufficiency: <br /> '� "� <br /> Office of the County Attorney 1� Pate: 9/3/2019_ <br /> Clerk to the Board <br /> Received for retard retention: <br /> All DocuSign contracts must be copied to Donna Lloyd upon completion @ Dolloyd 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 />