Dept/ Agency: Child and Family Well-Being Action: ( ) Ratifying (X) Authorizing ( ) Amending Type of Service: Professional Service Contract Purpose: Medical Director Consultant for the Department of Child and Family Well-Being Entity Name: Forest Hill Family Health Associates, P.A., providing the services of Thomas R. Ortiz, MD, as Medical Director Consultant Entity Address: 465 Mt. Prospect Avenue, Newark, New Jersey 07104 Contract Amount: Not to exceed $162,000.00 Funding Source: City of Newark Budget/Department of Child and Family Well-Being/Open-Ended Contract Period: January 4, 2013 through January 3, 2014 Contract Basis: ( ) Bid ( ) State Vendor ( X ) Prof. Ser. ( ) EUS ( ) Fair & Open ( ) No Reportable Contributions ( ) RFP ( ) RFQ ( ) Private Sale ( ) Grant ( ) Sub-recipient ( ) n/a Additional Information: