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2022-201A
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2022-201A
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Last modified
11/15/2022 10:34:43 AM
Creation date
11/15/2022 10:31:39 AM
Metadata
Fields
Template:
Official Documents
Official Document Type
Agreement
Approved Date
10/11/2022
Control Number
2022-201A
Agenda Item Number
8.A.
Entity Name
Critical Response Strategies, LLC
Subject
Agreement for Medical Services for persons with special needs (PSN) Shelter
Area
8955 85th Street Sebastian, FL or other location as determined by FDOH
Bid Number
2022058
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DocuSign Envelope ID: 10B3B763-0956-4CB1-990A-93BF6E604F54 <br />IN WITNESS WHEREOF, OWNER and PROVIDER have signed this Agreement in duplicate. One counterpart <br />each has been delivered to OWNER and PROVIDER. All portions of the Contract Documents have been <br />signed or identified by OWNER and PROVIDER or on their behalf. <br />This Agreement will be effective on October 11, 2022. <br />OWNER: PROVIDER: <br />INDIAN RIVER COUNTY Critical Response Strategies <br />f t>�.' •,ti :� DocuSignod by: <br />L <br />By. '.Bye <br />?P*rr�� i an i pQ: 655B75790A8 _.ard Caplin, Chairman <br />1l�Cf1 <br />Cr4s <br />By: CRffrAI RESPONSE <br />Jason E. ro n, County Administrator �'`•.tiR%yER C����'� E <br />•••.... <br />��• Attest_! <br />APPROVED AS TO FORM AND LEGA DEFICIENCY: <br />By: <br />Dylan Reingold, County Attorney <br />Jeffrey R. Smith, Clerk of Court and Comptroller <br />Attest:a2a4d-40tl <br />v <br />Deputy Clerk <br />(SEAL) <br />Designated Representative: <br />Name: <br />Title: <br />Address: <br />Phone <br />Email <br />11 <br />Address for giving notices: <br />6440 Southpoint Parkway, Suite 300 <br />Jacksonville, FL 32216 <br />License No. <br />(Where applicable) <br />Agent for service of process:, <br />Designated Representative: <br />Name: Danna Markham <br />Title: Chief Accounting Officer <br />Address: 6440 Southpoint Parkway, Suite 300 <br />Jacksonville, FL 32216 <br />Phone: <br />901-487-8598 <br />Email: dmarkham@caplinfamilyoffices.com_ <br />(If PROVIDER is a corporation or a partnership, <br />attach evidence of authority to sign.) <br />
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