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IN WITNESS WHEREOF, COUNTY and PROVIDER, by their respective authorized agents, have <br />caused this Agreement and its Schedules to be executed, effective as of the date by which all parties <br />hereto have affixed their respective signatures, as indicated below. <br />FOR PROVIDER: <br />Date Signed: <br />lxllLt /Z c 4 n -f <br />Date Signed: <br />Date Signed: iZ (� ( 2 <br />Date Signed: <br />FOR COUNTY: <br />JOSEPH PARISI, County Executive <br />KAREN PETERS, County Clerk <br />" [print name and title, below signature line of any person signing this document] <br />rev. 11/08 <br />Page 7 of 9 <br />