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Rout~ Order. (1) O~lgfnai~ng Depe~e~t, <br /> - ........... <br /> <br /> ORIGINATING DEPARTMENT <br />Contractor/Vendor: Good Health Services Vendor Number: 1253 <br />Purpose: In-Home Aide staff for CAP, PCS, HCCBG programs, contract RN <br />Amount: $2,376,491.00 Account # budgeted: 00195650-9110-TEMP <br />Department Number: 56-50 Dept. Rep. James H. Polk <br />TYPE OF CONTRACT: (Please Check One) [-INew I~Renewal Effective Date: 07/01/04 <br /> Expiration Date:06/30/05 <br />This document has been reviewed and approved by the Department Head as to technical content. <br /> <br />Checklist <br />[] County Policy Review <br /> <br />Original/copies to Vendor <br />Copies to originating Department <br /> <br />Department Head's Signature <br /> <br />NO I ES: <br /> <br /> [] Vendor W-9 <br /> <br />Distributed Copies <br /> [] Other Routing Instructions <br /> <br /> INFORMATION TECHNOLOGY DIRECTOR <br /> (Applicable only for hardware/software purchase or related services) <br />This document has been reviewed and approved by the Information Systems Director as to technical content. <br /> <br />IT Director's Signature <br /> <br />Date: <br /> <br /> REQUIRED APPROVALS <br />Doesthiscontractrequire Boar of Commissioneraction? Yes[~No[] Dateofaction <br /> <br />Does this contract require County Manager action? <br /> <br />Yes [] No [] Date of action <br /> <br />Date Received <br /> <br />CONTRACT ADMINISTRATOR <br /> <br />Yes [] No [] - Sufficient funds are available in the proper account to pay for this expenditure. <br />[] Pre-audit certification completed. Purchase Order/Encumbrance No. <br />Notes: <br />Yes [] No [] - A budget amendment is necessary before this agreement is approved. <br /> <br /> Yes [] No [] - A budget amendment is attached as required for approval of this agreement. <br /> <br />Contract Administrator's Signature Date: <br /> <br /> <br />