HomeMy WebLinkAboutR 2015-311-E DSS - OPT - Memorandum of Understanding to provide Medicaid transportation to eligible clients DocuSign Envelope ID:0806BD7C-9E5B-4DB8-9CC2-8583BB1 EA400
ORANGE COUNTY--DEPARTMENT USE ONLY
Department
Party/Vendor Name: Orange Public Transportation Party/Vendor Contact Person: Craig Benedict Contact Phone:
(919)245-2592 Party/Vendor Address: 600 Hwy City Hillsborough State: NC Zip:27278 Department: DSS
Amount: $12.75 per one way trip Purpose: Provide Medicaid transportation to eligible clients_ Budget Code(s):
10400020-760021 Vendor# (NIA if new vendor) Vendor is a BOCC consultant? Yes ❑No❑ Contract
Type: (Check one)New ❑ Renewal ® Amendment ❑ Effective Date 07/01/15 Approved by Board Yes®
No❑ Agenda Date:
This agreement is approved as to technical fo EloevsiiR py:
NAArt.G� Sf01�, 6/29/2015
Department Director's Signature �,Ea��nea.B�=� Date:
Information Technologies
(Applicable only to hardware/so_ftware purchases or related services)This agreement has been reviewed and is
approved as to information technology content and specifications:
Office of the Chief Information Officer Date:
Risk Management
This agreement is approved for sufficiency of insur g@agMw&y:speciVlit fcations, and requirements:
QUs& r,6 6 6/29/2015
Office of the Risk Management Officer 7FnrFan6an04g8_ Date:
Financial Services
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control
Art: DocuSigned by:
INAL tA+6VU
Office of the Chief Financial Officer BfFEZC-rte Date: 6/29/2015
Legal Services
This agreement is approved as to legal form and suf7u,,gned by:
6/29/2015
Office of the County Attorney l Date:
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd(a,oranQecountync.gov
The following signature block is for hard copies only and is not required for Docusign contracts:
Office of the Clerk to the Board Date: