A licensed physician who suffers from an impairment that affects their ability to actively practice medicine must report this impairment to the Medical Board at the time they renew their license.

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Answer 1

True, A licensed physician who suffers from an impairment that affects their ability to actively practice medicine must report this impairment to the Medical Board at the time they renew their license.

After your registration expires, you have a grace period of thirty days during which you can renew it without incurring any fees. The Medical Board makes your arrest record available to the public. Each time you are arrested, you are required to notify the Board right away.

Can you practice medicine in Texas with expired license?

However, neither the Texas Medical Board regulations nor the Texas Occupation Code authorize a doctor to practice without a valid license for even a single day. And to make matters worse, every day a doctor practices medicine without a valid license is regarded as a brand-new criminal offense.

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Related Questions

After instructing a mother about nutrition for a preschool-age child, which statement by the mother indicates correct understanding of the topic

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Make sure you give your baby an iron-fortified formula to supplementany stored breast milk you have.

The nurse should not make the mother feel guilty about her decision to begin bottle feeding to supplement breastfeeding.

What statement by the mother indicates correct understanding of the topic ?

She can give it to supplement any stored breast milk she might have in supply. She should emphasize the importance of giving the baby iron-fortified formula because fetaliron stores become depleted by 4 to 6 months of age

Infants younger than 1 year of ageshould not receive regular cow’s milk because it may place a strain on the immature kidneysBecause the baby weighs 14 pounds, he will require about 21 ounces of formula a day (not 36ounces), based on the nutritional recommendations that infants require 80 to 100 mL of formula or breast milk per kilogram of body weight per day.

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Sudden cardiac arrest is an abrupt occurrence where the heart ceases to function and results in death within minutes. According to the explanation of basic cpr, what is the first step to begin administering cpr?.

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Placing of the hand above the chest is the first step while administering CPR after ensuring that the environment is safe.

When the heart stops beating, CPR, or cardiopulmonary resuscitation, is a life-saving emergency operation. After cardiac arrest, immediate CPR can increase survival rates by a factor of two to three.

A person's heartbeat will cease if they are not breathing. To aid with circulation and to assist the body to receive oxygen, use CPR (chest compressions and rescue breaths). Following are the steps of CPR:

Placing of the hand above the chest. Interlocking of fingers.Giving chest compressions.Opening of the airway.Delivering rescue breathes. Watching the patient's chest fall.Repeat steps 3 and 4.

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An athlete who complains of severe pain located high on the front thigh muscle probably has an injury of the

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According to the research, an athlete who complains of pain located high on the front thigh muscle probably has an injury of the hip flexor.

What is the hip flexor?

They are a group of muscles located near the upper part of the thighs that allow the hip to flex, that is, to bring the thigh closer to the abdomen.

An athlete who has an injury of the hip flexor complains of tenderness in this muscle group and presents with pain on resisted hip flexion or stretching.

Therefore, we can conclude that according to the research, an athlete who complains of pain located high on the front thigh muscle probably has an injury of the hip flexor.

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Which diet change would the nurse encourage a patient with mild benign prostatic hypertrophy (BPH) to implement

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Reduction in caffeine will be suggested to a a patient with mild benign prostatic hypertrophy (BPH) to implement

As men age, a condition known as benign prostatic hyperplasia (BPH), or enlargement of the prostate gland, becomes more prevalent.Uncomfortable urinary symptoms, such as a bladder blockage, might be brought on by an enlarged prostate gland. It may also result in issues with the kidneys, urinary system, or bladder.Reduce your caffeine intake by drinking less coffee, soda, or energy drinks if you have BPH or prostatitis. Your urinary system's health can significantly improve if you avoid coffee. Water is another another vital beverage for your prostate. Do not try to drink less to lower your urine output instead, stay hydrated.

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The lack of affordable access to sufficient quality and quantity of healthy food is known as ______.

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The lack of affordable access to sufficient quality and quantity of healthy food is known as food insecurity.

Food insecurity occurs when every person in a household does not have consistent access to sufficient food . People need to have sufficient food in order to remain active and healthy.

Food insecurity can be caused by various reasons like poverty, low income,  unemployment, health conditions, and lack of access to healthcare.

Food insecurity can have various outcomes like serious health complications, children are unable to learn and grown as it affects their learning ability. People face difficulty in choosing where to spend their money, for food or other amenities.

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Occasionally three polar bodies are found clinging to the mature ovum. One came from an unequal division of the ovum, but from where did the other two arise?.

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Occasionally three polar bodies are found clinging to the mature ovum. One came from an unequal division of the ovum, but from where did the other two arise?.

Currently, an older adult in __________ can expect to live the longest in full health, without disease or injury.

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Currently, an older adult in Japan can expect to live the longest in full health, without disease or injury.

Japan is an island country in East Asia. Tokyo is the capital of Japan. Japan is one of the most densely populated countries in the world and is urbanized.

Japan has the highest life expectancy as compared to other countries. In Japan people live the longest in full health, as there are very less number of deaths due to ischemic heart diseases and cancer.

People are healthy in Japan as they consume very healthy foods like more of fish and seafood, green tea, soya bean , etc. Japanese people consume very less red meat and sugars. The Japanese diet helps people remain heathy.

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What should you do if a guest calls to report a foodborne illness they believe they got from eating at your establishment

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Inform the Health Department of the accusation of a foodborne illness and describe the actions to them and notify the owners and others on the management team of the incident.

Foodborne illness :

Foodborne illness is caused by consuming tainted foods or beverages. Foods can be contaminated by a wide range of pathogens or disease-causing bacteria, leading to a wide range of foodborne illnesses.

There are many similarities between the symptoms of 24-hour stomach flu and those of a foodborne infection, including nausea, vomiting, diarrhea, cramps, and headache. The digestive tract might suffer from excessive drinking and/or eating, particularly when rich foods are consumed outside of one's normal diet.

Symptoms of food poisoning typically take several hours to several days to emerge, depending on the pathogen.

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nurse is positioning a client for a urinary catheterization. Which of the following nursing actions would be best in preventing musculoskeletal injuries during the procedure

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Raising the bed to a comfortable height would be best in preventing musculoskeletal injuries during the procedure of urinary catheterization.

Inserting an indwelling urethral catheter (IDC) requires a labor-intensive procedure that should only be carried out in an aseptic environment. A doctor will frequently insert a urinary catheter. They are inserted through the tube that drains urine out of the bladder.

It is more ergonomically sound to work from a bed that is at a comfortable height to avoid back pain and potential injuries, as well as to avoid bending and/or twisting from the waist.The patient is positioned upright thanks to the tilt of the bed, which has positive effects on the patient's healing, blood pressure, and circulation. The lungs and circulatory system can benefit from the cardiac chair position.Due to the influence of gravity, raising the bed's head reduces the amount of blood returning to the heart. Here, the diminished blood return to the heart may result in a reduction in blood pressure.

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What term is used to indicate that an ambulance service entity is associated with a medical facility?

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The term is used to indicate that an ambulance service entity is associated with a medical facility is called Provider.

Emergency medical services (EMS), also known as ambulance services or paramedic services, are emergency services that provide urgent pre-hospital treatment and stabilization for serious illness and injuries and transport to definitive care.

They may also be known as a first aid squad FAST squad, emergency squad, ambulance squad, ambulance corps, life squad or by other initialisms such as EMAS or EMARS.

Ambulances are the primary vehicles for delivering EMS. These agencies may also operate a non-emergency patient transport service, and some have rescue squads to provide technical rescue services.

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Correct Each row of the table below describes an aqueous solution at . The second column of the table shows the initial components of the solution. Use the checkboxes in the third column to explain the type of the initial solution. The fourth column describes a change in the solution. Use the fifth column to predict how the change in the solution will change its pH.

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Based on the given table;

A is a basic solution; addition of HClO₄ makes pH lower.

B is a neutral solution; addition of KI make pH stay same.

C is an basic solution; addition of NaClO₄ makes pH stay same.

D is a neutral solution; addition of KOH makes pH higher.

What changes occur in the pH of the solutions?

The pH of a solution is a measure of the acidity or alkalinity of the solution.

Solutions of pH less than 7 are acidic solutions whereas solutions of pH greater than 7 are basic solutions. Solutions of pH 7 are neutral solutions.

Addition of acids to an acid solution, will decrease the pH, while addition of a base will increase the pH.

Conversely, addition of a base to an basic solution will increase its pH whereas, addition of an acid will decrease the pH of the solution.

Based on the given table;

A is initially a solution; addition of HClO₄, an acid will make pH lower.

B is a neutral solution, addition of a neutral salt such as KI will make pH stay same.

C is an basic solution. When NaClO₄ is added, pH will be same.

D is neutral. Add KOH, and pH will be higher.

In conclusion, pH of a solution is affected by addition of acids, salts or bases.

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When teaching a patient with osteoarthritis (OA) of the left hip and lower lumbar vertebrae about management of the condition, the nurse determines that additional instruction is needed when the patient say

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"I should try to stay active throughout the day to keep my joints from becoming stiff

Patients with osteoarthritis should protect their joints and prevent joint stresses, therefore they should alternate rest periods with necessary activity. The other patient comments show that the instruction was successful. The most prevalent type of arthritis, osteoarthritis, affects millions of individuals worldwide. When the protective cartilage that cushions the ends of the bones gradually deteriorates, it happens. Although osteoarthritis can harm any joint, it most frequently affects the hands, knees, hips, and spine joints. The destruction of cartilage, a rubbery substance that reduces friction in your joints, is the primary cause of osteoarthritis. The spine, fingers, thumbs, hips, knees, or big toes are the most common places for it to occur, yet it can develop in any joint. Older persons are more likely to get osteoarthritis.

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A nurse is discussing decontamination with a newly licensed nurse. The nurse identifies understanding if the newly licensed nurse identifies which of the following agents as needing decontamination

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The keys to decontamination which must be understood by the newly licensed nurse are

pre-sterilisation cleaning.disinfectioninspectionsterilisationstorage

What is decontamination agents?

Decontamination simply refers to the process of removing the contamination of infectious agents or other contaminants

So therefore, the keys to decontamination which must be understood by the newly licensed nurse are: pre-sterilisation, cleaning, disinfection, inspection, sterilisation and storage.

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A 35 year old man is pulseless and apneic. He was found in a lake after falling through the ice. His wife says he left the house 3 hours ago. His is cold and rigid. What should you do

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A 35 year old man is pulseless and apneic. He was found in a lake after falling through the ice. His wife says he left the house 3 hours ago. His is cold and rigid. We will perform "Perform chest compressions."

What is chest compressions?

The act of exerting pressure to somebody's chest in an emergency circumstance to aid blood flow through heart is known as chest compression. Give five chest compressions after one mouth-to-mouth resuscitation breath.

Some key points of the chest compression are-

Less than one minutes to 65 minutes were spent compressing the chest.For all age groups, maintain compressions at a rate of one hundred compressions per minute, allowing the chest to rebound in between.However, the resuscitation infrastructure that already exists, such as portable defibrillators, chest compressions, and mouth-to-mouth ventilation, cannot be disregarded.He provided compelling evidence to show that mouth-to-mouth respiration was necessary in addition to chest compression for successful ventilation.Chest compressions are still advised even if they are deemed ineffective in people who have suffered heart attack due to trauma.The effectiveness of chest compressions can be enhanced by these devices, according to several published reviews.

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The nurse is caring for a client with a continuous feeding through a percutaneous endoscopic gastrostomy (PEG) tube. Which intervention should the nurse include in the plan of care

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The nurse's intervention should include in the care plan the possible leakage of stomach (or tube) contents around the tube orifice, displacement or dysfunction of the tube. Other complications inherent to the procedure are infection of the skin around the tube, aspiration, bleeding and perforation of other viscera.

What is Percutaneous Endoscopic and Gastrostomy?

Percutaneous Endoscopic Gastrostomy (PEG) is a procedure in which a flexible feeding tube is passed into the stomach through the abdominal wall. A gastrostomy allows nutrition, fluids and medication to be placed directly into the stomach, without passing through the mouth and esophagus.

With this information, we can conclude that Endoscopic Gastrostomy is a procedure that combines endoscopy techniques to introduce a tube that passes through the wall of the abdomen and goes straight to the digestive tract.

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The physical activity health guidelines require metabolizing about _____ calories during moderate physical activity during most days of the week.

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The physical activity health guidelines require metabolizing about 150 to 400 calories during moderate physical activity on most days of the week.

The intake of calories in the food provides the energy to do work. A very low intake of calories may result in weight loss and too much of it can make you obese. Physical activities like exercise, cycling, and jogging are necessary to burn calories.  

According to the physical activity health guidelines, adults must do moderate physical activity for at least 2hr a week. And 1 hr intense aerobic exercise a week to burn the calories.

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An invasive imaging technique that provides color-coded images of brain activity by tracking the brain’s use of a radioactively tagged compound, such as glucose, oxygen, or a drug, is called?

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An invasive imaging technique that provides color-coded images of brain activity by tracking the brain’s use of a radioactively tagged compound is positron emission tomography.

What is positron emission tomography (PET)?

Positron emission tomography (PET) is a methodology used in clinical settings to identify a given reactive isotope.

Positron emission tomography may result very useful to observe in vivo a given physiological mechanism.

In conclusion, an invasive imaging technique that provides color-coded images of brain is positron emission tomography.

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The nurse reinforces teaching to the parents of a 12-month-old who has begun weaning from breastfeeding. Which statement by the parents indicates that teaching has been effective

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I can start substituting breastfeeding sessions with whole cow's milk is the correct statement by the parents which will indicate that the teaching by the nurse has been effective.

What is Weaning?

This is the process in which a baby is moved from breastfeeding to other types of food sources such as solids. This usually takes time as a lot of patience is required due to the baby having to adapt gently to the new conditions so as to achieve the aim.

This usually occurs after six to 12 month depending on the decision by the parents in which the baby has gotten the appropriate nutrients from breast milk. In this case, cow milk can be used as a substitute in the diet of the child.

This is therefore the reason why it was chosen as the most appropriate choice in this scenario.

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After being sick for 3 days, a client with a history of diabetes mellitus is admitted to the hospital with diabetic ketoacidosis (DKA). The nurse should evaluate which diagnostic test results to prevent dysrhythmias

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The nurse should evaluate the serum potassium level in diagnostic test results to prevent the emergence of dysrhythmias.

What is diabetes mellitus?

Diabetes mellitus is a disease where the individual is unable to control internal levels of glucose in the blood.

Diabetic ketoacidosis (DKA) is a type of complication in diabetes condition where the individual produces high levels of ketones, which are a serious problem for the organism.

In conclusion, the nurse should evaluate the serum potassium level in  to prevent dysrhythmias.

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To assess body composition and central obesity, health-care professionals most often use BMI and ________.

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To assess body composition and central obesity, health professionals often use BMI and central fat.

What is central obesity?

Also known as central obesity, fat is mainly located in the upper part of the body (visceral fat). Also known as obesity, in which fat is located mainly in

the lower bodybuttocks and thighs.

With this information, we can conclude that The human body is made up of different types of tissues. Adipose tissue, muscles, bones, blood, vital organs and all the water distributed by the body add up to the total mass or body weight that we see when stepping on the scale.

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Which diagnostic findings will the nurse expect when caring for a patient who is a experiencing worsening of asthma symptoms

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At first it could have hypoxemia with hypocapnia respiratory alcalosis then after some time the patient could even have status astamaticus with hypoxemia hipercapnia and metabolic acidosis .

A nursing student is preparing a class for new mothers about adaptations they can expect in their newborns. Which information about newborn vision should the student include in the presentation

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Newborn Babies have the ability to focus only on objects in close proximity.

Newborn Babies' eye movements might not be coordinated. They might even have crossed eyes. Newborn Babies can only focus at close range when they are born. The distance between a mother's face and the newborn babies in her arms is around 8 to 10 inches.
In the first few weeks of life, infants may follow or track an object. Over the first two to three years of life, focus develops to a typical 20/20 vision. Although they can't see all colors, newborn babies can perceive light and dark.
Babies have not yet fully developed the ability to distinguish easily between two targets or shift their eyes between the two images, despite the fact that they may focus intensively on a target with great contrast. Their main interest is in things. Their main attention is on things that are 8 to 10 inches away from them or the parent's face.

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The nurse working in the emergency department places a client in anaphylactic shock on a cardiac monitor and sees the cardiac rhythm shown. Which dysrythmia should the nurse document

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The dysrhythmia the nurse should document is the heart rate, peak airway pressure, and blood pressure.

What is anaphylactic shock?

It is the most serious form of hypersensitivity reaction (allergy), triggered by various agents such as drugs, food and radiological contrast agents. Signs and symptoms may begin within seconds of exposure to the agent or up to an hour later.

With this information, we can conclude that Anaphylactic shock occurs when a person comes into contact with a substance that excites the immune system, causing the body to overreact.

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The motor pathway of the autonomic nervous system usually involves __________ neurons.

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The motor pathway of the autonomic nervous system usually involves two neurons.

The part of the nervous system that controls involuntary functions is called the autonomic nervous system (ANS). It is made up of autonomic neurons, which are neurons that carry impulses from the brain and/or spinal cord to glands, smooth muscle, and cardiac muscle. ANS neurons are responsible for a wide variety of tasks, including the regulation of heart rate and peristalsis (the movement of smooth muscle in the digestive tract), as well as the regulation of the secretions of some glands, such as the salivary gland.

The preganglionic and the postganglionic neuron make up the connection in the ANS between the Central Nervous System and its effector. This connection is found in the autonomic nervous system. An autonomic ganglion serves as the location of the synapse that connects these two neurons, which are located outside of the CNS.

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Which clinical manifestations are appropriate when assessing a school-age child with attention-deficit/hyperactivity disorder (ADHD) - Inattentive type

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Clinical manifestations for attention-deficit/hyperactivity disorder (ADHD) - Inattentive type include:

Pay less attention to details and commit thoughtless errors.Having trouble organizingProne to distractionAvoid or detest jobs that demand much consideration.

People with attention-deficit/hyperactivity disorder (ADHD) struggle with issues brought on by impulsivity, hyperactivity, and/or a short attention span. Between 2 and 4 percent of adults and between 5 and 8 percent of school-age children are diagnosed with ADHD. It is a hereditary disorder that runs in a family.

Children with ADHD frequently struggle at home, at school, or when interacting with other kids. Children with ADHD, for instance, may struggle to finish work, adhere to rules, or get along with peers.

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The nurse has just applied a sterile pressure dressing to an epidural site after removing the epidural catheter in a client who is now recovering from a standard delivery. Which action should the nurse now prioritize

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In a client who is now recovering following a typical delivery, the nurse has just put a sterile pressure dressing on an epidural site after removing the epidural catheter. respiratory depression is now given priority by the nurse.

Epidural anesthetic complications including respiratory depression should be closely watched in patients who are in labor. A spinal epidural block's side effects include a failure block, an unintended intrathecal block, and a post-dural puncture headache (spinal).

In the care and management of patients receiving epidural analgesia, nurses play a crucial role. Monitoring, recording, determining the degree of sensory and motor block, managing the insertion site and dressings, caring for the pressure region, and withdrawing the epidural catheter are all part of this duty.

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What process a simulates what a regular hardware computer can do through a software package

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Virtualization software simulates what a regular hardware can do through a software package.

what do you mean by virtualization software ?

You may run two or more operating systems on one PC by using virtualization software. Thus, it works as two or more computers in one. The others are virtual, and one is physical. examples are Citrix, which specializes on application virtualization but also offers server virtualization and virtual desktop solutions, and VMware, which specializes in server, desktop, network, and storage virtualization.

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Each of the following must be disclosed to the patient before obtaining informed consent for dental radiographs except one. Which one is the EXCEPTION

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The rights of the patient as the owner of the images are the exception to the patient before obtaining informed consent for dental radiographs.


Dental radiographs,
sometimes known as x-rays, are a crucial component of your dental care. They give your dentist a fuller picture of what's going on in your mouth than an oral examination alone.

Your dentist can detect diseases and developmental disorders using dental radiographs before they worsen. Early injury or infection discovery can help restrict or stop subsequent harm to other oral sites. Your dentist may be informed of changes in your hard and soft tissues through dental radiographs. Radiographs in youngsters enable the dentist to monitor the growth of the jawbone and teeth. Dental radiographs, like medical radiographs, let your dentist assess any facial and oral injuries you may have.


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A client diagnosed with delusional disorder is experiencing persecutory delusions involving the belief that someone is putting poison in his food. When developing the client's plan of care, which nursing diagnosis would be most likely

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Nursing diagnosis would be social isolation due to inability to trust.

Persecutory delusional disorder is a false belief that  is completely   different from the true evidence.

In persecutory delusional disorder people are occupied with some false beliefs that they are going to be mistreated. Individuals who suffer from psychotic conditions like paranoid schizophrenia, may experience persecutory delusional disorders.

Persecutory delusional disorders can be managed with the help of therapy and medications.

Nursing diagnosis would be social isolation as the client in unable to trust.

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Type, frequency, time, and rest are examples of what aspect of fitness? Elements of a fitness program Acute training variables Periodization Training cycles

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Type, frequency, time, and rest are examples of acute training variables.

The acute training variables can be used by the strength and conditioning coach to control the workload during each training unit or session. Indicators of acute training include:

The amount of training units in a week is known as frequency.Exercise's effort is measured by its intensity.Time is the length of exercise (or specified repetitions)The selection and sequencing of exercises, called type.

The strength and conditioning coach may carry out such a program one to three times a week, depending on the players' level of growth and the availability of training opportunities.

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The coefficient of performance of a refrigerator represents the amount of heat removed from the refrigerated space for each unit of work supplied.T/F A bag with 6 marbles has 2 blue marbles, 1 red marble, and 3 yellow marbles. A marble is chosen from the bag at random. What is the probability that it is blueor red?Write your answer as a fraction in simplest form.X in terms of unintentional injuries, falls disproportionately affect: HELP ITS URGENT!!!!!Which two line features of both poems support the answer to part AA. Lines 1-4 and 5-8 have an abba rhyme scheme.B. The first stanza of each poem has eight lines C. Both poems contain natural themes. D. Each poem has fourteen linesIt is also from "Pretty Words by elinor wylie." which of the following institutions most limit the exercise of independent legislative power? Comparing Two Stocks In this section, we will use Monte Carlo simulation to estimate probabilities relating to the performance of two stocks with different parameters. Create a markdown cell that displays a level 2 header that reads: "Part F: Comparing Two Stocks". Also add some text briefly describing the purpose of your code in this part. Set a seed of 1, and then run Monte Carlo simulations for two stocks (Stock A and Stock B), each with 10,000 runs lasting over a period of 252 days. Both stocks being simulated have a current price of 120. Stock A has an expected annual yield of 8% and a volatility of 0.2. Stock B has an expected annual yield of 5% and a volatility of 0.5. Calculate the following: The proportion of the simulated runs in which Stock A has a higher final price than Stock B. The proportion of the simulated runs in which Stock A has a final price greater than 150. The proportion of the simulated runs in which Stock B has a final price greater than 150. The proportion of the simulated runs in which Stock A has a final price less than 100. The proportion of the simulated runs in which Stock B has a final price less than 100. Round all values to four decimal places, and display your results in the following format: Proportions of runs in which What was the Russian Revolution 1917 to 1922? which of the following cranial nerves has both sensory and motor functions? research suggests that hypnosis is effective in reducing pain because it Which of the following transactions would typically result in the creation of a deferred tax liability? a. Gross profit on installment sales is recognized currently in pretax financial income but is not taxable for income tax purposes until cash is received. b. Losses recognized in pretax accounting income from an investment in a subsidiary are accounted for by the equity method but not deductible for income tax purposes until the investment is sold. c. Rents received in advance are taxable when received but are not recognized in pretax financial income until earned. d. A contingent liability is recognized as an expense currently in pretax financial income but not deductible for income tax purposes until paid. Set course_student's last_name to Smith, age_years to 20, and id_num to 9999. Sample output for the given program:Name: Smith, Age: 20, ID: 9999code:class PersonData:def __init__(self):self.last_name = ''self.age_years = 0def set_name(self, user_name):self.last_name = user_namedef set_age(self, num_years):self.age_years = num_years# Other parts omitteddef print_all(self):output_str = 'Name: ' + self.last_name + ', Age: ' + str(self.age_years)return output_strclass StudentData(PersonData):def __init__(self):PersonData.__init__(self) # Call base class constructorself.id_num = 0def set_id(self, student_id):self.id_num = student_iddef get_id(self):return self.id_numcourse_student = StudentData()last_name = 'Smith'age_years = 20id_num = 9999print('%s, ID: %s' % (course_student.print_all(), course_student.get_id())) sarasota, florida's financial statements refer to an entity called the downtown improvement district (DID). Based on the following information, state (1) whether DID should be reported as a component unit of Sarasota and (2) if, so, whether it should be blended or discretely reported. Give reasons for your answers. DID was created by City ordinance. The physical boundaries include all non-residential parcels of property within the downtown core of the City of Sarasota. The City refers to DID as a "dependent taxing authority" because DID has the power to levy up to two mills of property taxes - with the approval of the City Commissioners - for the purpose of purchasing supplemental services such as maintenance. security, sanitation, promotions, infrastructure, and capital improvements. 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