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9 LAKE COUNTY SCHOOLS Leading our Children to Success Procurement Services CR 561 Tavares FL (352) Fax: (352) Superintendent: School Board Members: Susan Moxley, Ed.D. District 1 Bill Mathias District 2 Rosanne Brandeburg District 3 Tod Howard District 4 Debbie Stivender District 5 Kyleen Fischer July 17, 2014 Mr. Bradley Bennett Maxim HealthCare Services, Inc. dba Maxim Staffing Solutions 7227 Lee DeForest Drive Columbia, Maryland RE: Bid #3534DB Nursing Services for Lake County Schools Dear Mr. Bennett: At their meeting held on June 23, 2014, the Lake County School Board accepted your offer to renew your annual contract for the above referenced bid. The contract terms and conditions in this agreement will be firm through August 12, Enclosed, for your records, is an executed copy of your agreement with the Lake County School Board. Per contract specifications, it is your responsibility to provide the Purchasing Department with current copies of your certificate of insurance naming the School Board of Lake County, Florida, as an additional insured and to maintain the required coverages for the duration of the contract term. If you have not already done so, please forward this information as soon as possible. Failure to submit a fully completed original certificate of insurance signed by an authorized representative of the insurer providing such coverage may cause your company to be in default and subject to cancellation of the contract. We look forward to working with you during this contract period. If you have questions, please call me at (352) Sincerely, Deborah Gardner, CPPB Certified Assistant Purchasing Agent Equal Opportunity in Education and Employment

10 EXTENSION TO AGREEMENT FOR CONTRACTOR SERVICES This Contract Extension is made as ofthe013~ay of ~, 2014, between the School Board of Lake of County, Florida ("School Board"), and Maxim Staffing Solutions ("Contractor"). WITNESSETH: xim HealthCare Services, Inc. dba THAT, on August 13, 2012, the parties entered into an Agreement for Contractor Services whereby the Contractor agreed to provide nursing services (the "Agreement"). NOW, the parties wish to extend the term of the Agreement for an additional 12 months, up through and including August 12,2015. NOW, THEREFORE, in consideration of the mutual benefits accruing to the parties and for other good and valuable considerations, the receipt and sufficiency of which are hereby acknowledged, the parties agrees as follows: 1. Recitals. The above recitals are true and correct and by reference are incorporated herein and made a part hereof. 2. Extension. The Agreement is hereby extended through August 12, Modification. Except as specifically modified by this Contract Extension, the terms and conditions of the Agreement shall continue in full force and effect as originally executed. Nothing herein shall be deemed or construed to modify any other contract or undertaking between the parties other than as defined above. 4. Public Records Retention. CONTRACTOR shall keep and maintain public records that ordinarily and necessarily would be required by SCHOOL BOARD in order to perform the services being provided by CONTRACTOR herein. CONTRACTOR shall provide the public with access to public records on the same terms and conditions that the SCHOOL BOARD would provide the records and at a cost that does not exceed the cost provided in Chapter 119, Florida Statutes. CONTRACTOR shall ensure that public records that are exempt or confidential and exempt from public records disclosure requirements are not disclosed except as authorized by law. CONTRACTOR shall meet all requirements for retaining public records and transfer, at no cost, to the SCHOOL BOARD all public records in possession of the CONTRACTOR upon termination of this Agreement and destroy any duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. All records stored electronically must be provided to the SCHOOL BOARD by CONTRACTOR in a format that is compatible with the information technology systems of the SCHOOL BOARD.

11 IN WITNESS WHEREOF, the parties hereto have made and executed this Contract Extension on the respective dates under each signature: SCHOOL BOARD OF LAKE COUNTY, FLORIDA MAXIM HEALTHCARE SERVICES, INC. DBA MAXIM S FING SOLUTIONS Chairperson Date: Date: _Sf_.:_( a_!~f_l l(-'---_ Attest: s~

12 LAKE COUNTY SCHOOLS Leading our Children to Success Procurement Services CR 561~ 1 Tavares FL (352) Fax: (352) Superintendent: Sclrool Board Members: Susan Moxley, Ed.D. District 1 Bill Mathias District 2 Rosanne Brandeburg District 3 Tod Howard Dlstrict4 Debbie Stlvender District 5 Kyleen Fischer RENEWAL OPTION March 21, 2014 Mr. Bradley Bennett Maxim HealthCare Services, Inc. dba Maxim Staffing Solutions 7227 Lee DeForest Drive Columbia, Maryland RE: Bid #3534DB Nursing Services for Lake County Schools Dear Mr. Bennett: The above referenced bid is currently awarded to your company, but unfortunately will expire on August 12, The School Board of Lake County would be interested in renewal of this bid, per contract specifications, by your company if possible. Please complete the form below to indicate whether you wish to renew. Please return to our office by April 4, A sworn statement under section (3), (a), Florida Statutes, on Public Entity Crimes has also been included. Please fill out and return signed original before the commencement of contract on August 13, Thank you in advance for your assistance in this bid renewal. Please contact me at or at gardnerd@lake.k12.fl.us if you have any questions. Sincerely;./j lqv~ ~a.j~d.,t..'-.1!~ Deborah Gardner, Assistant Purchasing Agent Maxim Health Care Services, Inc. dba Maxim Staffing Solutions is in agreement for renewal of the above referenced bid at the original bid prices. Period of agreement shall be an additional twelve months, expiring on August 12, Please Check One: I agree to renew at approved contract prices. myes DNo "Equal Opporlunity In Education and Employment"

13 SWORN STATEMENT UNDER SECTION (3)(a), FLORIDA STATUTES, ON PUBLIC ENTITY CRIMES This form must be signed. and sworn to in the presence of a notary public or other officer authorized to administer oaths. 1. This sworn statement is submitted to Lake County Schools by Klrstyn Estes, Assistant Controller for Maxim Healthcare Services, Inc., dba Maxim Staffing Solutions Whose business address is: 2002 N. Lois Ave, Suite 130, Tampa, FL (If applicable) its Federal Employer Identification Number (FEIN) is: (If the entity has no FEIN, include the Social Security Number of the individual signing this sworn statement on the attached sheet.) Required as per IRS Form W I understand that a "public entity crime" as defined In Paragraph (1 )(g), Florida Statutes, means a violation of any state or federal law by a person with respect to and directly related to the transaction of business with any public entity or with an agency or political subdivision of any other state or with the United States, including but not limited to, and bid or contract for goods or services to be provided to any public entity or agency or political subdivision or any other state or of the Unites States, and involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation. 3. I understate that "convicted" or "conviction" as defined in Paragraph (1 )(b), Florida Statutes, means a finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in any federal or state trial court of record relating to charges brought by indictment or information after July 1, 1989, as a result of a jury verdict, nonjury trial, or entry of a plea of guilty or nolo contendere. 4. I understand that "affiliate" as defined in Paragraph (1)(a), Florida Statutes means: A. A predecessor or successor of a person convicted of a public entity crime or; B. An entity under the control of any natural person who is active in the management of the entity and who has been convicted of a public entity crime. The term "affiliate" includes those offices, directors, executives, partners, shareholders, employees, members, and agents who are active in the management of the affiliate. The ownership by one person of shares constituting a controlling interest in another person, or a pooling of equipment or income among persons when not fair market value under an arm's length agreement, shall be a facie case that one person controls another person. A person who knowingly enters into a join venture with a person who has been convicted of a public entity crime in Florida during the proceeding 36 months shall be considered an affiliate. 5. I understand that a "person" as defined in Paragraph (1)(c), Florida Statutes. means any natural person or entity organized under the laws of any state or of the United States with the legal power to enter a binding contract and which bids or applies to bid on contracts for the provision of goods or services let by a public entity, or which otherwise transacts or applies to transact business with a public entity. The term "person" includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in management of the entity. 6. Based on information and bel.ief, the statement, which I have marked below, is true in relation to the entity submitting those sworn statements. (Please indicate which -statement applies.)

14 [8] Neither the entity submitted this sworn statement, nor any officers, directors, executives, partners, shareholders, employees, members, and agents who are active in management of an entity nor affiliate of the entity have been charged with and convicted of a public entity crime subsequent to July 1, The entity submitting this sworn statement, or one or more of the officers, directors, executives, partners, shareholders, employees, member, or agents who are active in management of the entity, or an affiliate of the entity have been charged with and convicted of a public entity crime subsequent to July 1, The entity submitting this sworn statement, or one or more of its officers, directors, executives, partners, shareholders, employees, member, or agents who are active in management of the entity, or an affiliate of the entity has been charged with and convicted of a public entity crime subsequent to July 1, However, there has been subsequent proceeding before a Hearing Officer of the State of Florida, Division of Administrative Hearing and the Final Order entered by the Hearing Officer determined that it was not in the public interest to place the entity submitting this sworn statement on the convicted vendor list. (Attach a copy of the final order) I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE CONTRACTING OFFICER FOR THE PUBLIC ENTITY IDENTIFIED IN PARAGRAPH 1 (ONE} ABOVE IS FOR THAT PUBLIC ENTITY ONLY AND, THAT THIS FORM IS VALID THROUGH DECEMBER 31 OF THE CALENDAR YEAR IN WHICH IS FILED. I ALSO UNDERSTAND THAT I AM REQUIRED TO INFORM THE PUBLIC ENTITY PRIOR TO ENTERING INTO A CONTRACT IN EXCESS OF THE THRESHOLD AMOUNT PROVIDED IN SECTION , FLORIDA STATUTES, FOR CATEGORY TWO,?JI;A~~ CHAN(.JE I~ THE INFORMATION CONTAINED IN THIS FORM. STATE OF county of Mc..r-ilf-V!J Hw,fAf"~ PERSONALLY APPEARED BEFORE ME, the undersigned authority, K~r~AiYl l?sies (Name of individual signing) who, after first being sworn by me, affixed his/her signature in the space provided t.b lh above~ NOh, z.<ji'l. ;?.OTARYfiUBLIC),...- My Commission Expires: e>~hlber Q?a, Jolt[ KElt~ J RAMALHO Notary Public-Maryland Baltimore City My Commission Expires October 28, 2014

15 Detail by FEI/EIN Number Page 1 of3 Detail by FEI/EIN Number Foreign Profit Corporation MAXIM HEAL THCARE SERVICES, INC. Filing Information Document Number FEIIEIN Number Date Filed State Status Last Event Event Date Filed Event Effective Date P /05/1990 MD ACTIVE NAME CHANGE AMENDMENT 11/24/1993 NONE Principal Address 7227 LEE DEFOREST DRIVE COLUMBIA, MD Changed: 01/24/2011 Mailing Address 7227 LEE DEFOREST DRIVE COLUMBIA, MD Changed: 01/24/2011 Registered Agent Name & Address CORPORATION SERVICE COMPANY 1201 HAYS STREET TALLAHASSEE, FL Name Changed: 10/21/1998 Address Changed: 10/21/1998 Officer/Director Detail Name & Address Title PRES BENNETT,W.BRADLEY 7227 LEE DE FOREST DR COLUMBIA, MD /search. sunbiz.org/inquiry /CorporationSearch/SearchResultDetail/F ein umber/forp-p2... 4/18/2014

16 Detail by FEIIEIN Number Page 3 of3 05/02/ ANNUAL REPORT View image in PDF format 01/26/ ANNUAL REPORT ~=V=i=ew=im=a=g=e=in=P=D=F=fo=r=m=at=~ 03/17/ ANNUAL REPORT View image in PDF format 02/14/ ANNUAL REPORT ~==V=ie=w=im=a:::g:::e=in=P=D=F=fo=rm=a=t=~ 08/21/ ANNUAL REPORT View image in PDF format 04/11/ ANNUAL REPORT ~==V=ie=w=im=a=g=e=in=P=D=F=fo=rm=a=t=~ 03/08/ ANNUAL REPORT View image in PDF format ~==============~ 10/21/ Reg. Agent Change :===V=ie=w=im=a=g=e=in=P=D=F=fo=rm=a=t====: 03/25/ ANNUAL REPORT View image in PDF format 03/07/ ANNUAL REPORT :===V=ie=w=im=a:::g:::e=in=P=D=F=fo=rm=a=t=~ 02/28/ ANNUAL REPORT View image in PDF format 02/01/ ANNUAL REPORT ~=V=i=ew=im=a=g=e=in=P=D=F=f=or=m=a=t =~ ~ and Privacy Policies State of Florida, Department of State /search. sunbiz.org/inquiry /CorporationSearch/SearchResultDetail/F einumber/forp-p2... 4/18/2014

17 LAKE COUNTY SCHOOLS Leading our Children to Success Procurement Services CR 561 Tavares FL (352) Fax: (352) Superintendent: School Board Members: Susan Moxley, Ed.D. District 1 Jim Miller District 2 Rosanne Brandeburg District 3 Tod Howard District 4 Debbie Stivender District 5 Kyleen Fischer NOTICE OF AWARD September 14, Mr. Bradley Bennett Maxim HealthCare Services, Inc. dba Maxim Staffing Solutions 7227 Lee DeForest Drive Columbia, Maryland RE: Bid #3534DB Nursing Services for Lake County Schools Dear Mr. Bennett: At their meeting held on August 13, 2012, the Lake County School Board approved the award of Bid #3534DB Nursing Services for Lake County Schools as shown below. A copy of the recommendation letter and tabulation sheet is posted on the LCSB Purchasing Department s website located at A copy of your contract is enclosed. Maxim HealthCare Services, Inc. located in Columbia, Maryland - Primary vendor SHC Services, Inc. dba Supplemental Health Care located in Park City Utah - Alternate vendor Per contract specifications, it is your responsibility to provide the Purchasing Department with current copies of your certificate of insurance naming the School Board of Lake County, Florida, as an additional insured and to maintain the required coverages for the duration of the contract term. If you have not already done so, please forward this information as soon as possible. Failure to submit a fully completed original certificate of insurance signed by an authorized representative of the insurer providing such coverage may cause your company to be in default and subject to cancellation of the contract. The contract will be in effect through September 12, Purchase orders will be issued as needed. We look forward to working with you. If you have questions, please contact me at or at bennettd@lake.k12.fl.us. Sincerely, Diane Bennett, CPPO Certified Purchasing Agent Enclosure Equal Opportunity in Education and Employment

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