Common Contracts
1 similar Revenue Agreement contracts
DEPARTMENT OF HEALTH – TWO-PARTY AGREEMENT INFORMATION SHEET DH1122-ARevenue Agreement • September 4th, 2019
GENERAL CONTRACT DESCRIPTION GENERAL INFORMATION AGREEMENT NUMBER(if applicable) CHD/DIVISION/OFFICE PINELLAS/ENVIRONMENTALHEALTH/CHILD CARE LICENSING PROGRAM CONTRACT TYPE RA-REVENUE AGREEMENT CONTRACT AMOUNT $660,022.00 DATE OF EXECUTION BEGINNING DATE OCTOBER 1, 2019 ORIGINAL END DATE SEPTEMBER 30, 2019 NEW ENDING DATE SEPTEMBER 30, 2020 STATUTORY AUTHORITY FS 402.306CH 61-2681 CONTRACT MANAGER INFORMATION LAST NAME BORNOFF FIRST NAME FAITH PHONE 727-507-4857 EXTENSION DATE OF LAST DOH CERTIFICATION: 11-29-2017 DATE OF ADV. ACCOUNTABILITY or FCCM 5-30-2018 VENDOR INFORMATION VENDOR ID VENDOR NAME JUVENILE WELFARE BOARD OF PINELLAS COUNTY ADDRESS 14155 58TH ST. NORTH, SUITE 100 CITY/STATE/ZIP CLEARWATER, FL 33701 CONTACT PERSON CHERYL MILLER CONTACT E-MAIL ADDRESS cmiller@jwbpinellas.org PHONE NUMBER 727- 453 -5617 PART II: CONTRACT ACTIONS Contract Actions are all actions related to the contract after the initial execution of the agreement with theprovider. ActionType
