HomeMy WebLinkAboutR 2016-134-E DSS - Chatham Transit Network for Medicaid transportation DocuSign Envelope ID: 55869249-DO71-43C6-B9B7-126B43EDD48D
ORANGE COUNTY-DEPARTMENT USE ONLY
Department
Party/Vendor Name: Chatham Transit Network Party/Vendor Contact Person. Anna Testen-nan Contact Phone:
919-542-5136 Party/Vendor Address: PO Box 1032 City Pittsboro State: NC Zip: 27312 Department: DSS
Amount: $10 0_00 Purpose: Medicaid Trgn,��� Budget Code(s): _ Vendor # - (N/A if new
vendor) Vendor is a BOCC consultant? Yes 7 NoZ Contract Type: (Check one) New Z Renewal
Amendment F-1 Effective Date 07/01/15 Approved by Board YesF_1 No7 Agenda Date:
This agreement is approved as to technical form 6ambbd by:
Department Director's Signature .� _ (,46v, Date: .. 2/3/2016
i 7N M5-----------------
Information Technologies
(,4pplicable only to hardwareAqf4vare 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 Mana2emen
This agreement is approved for sufficiency of insurar6gar!§,,Wid6y:specifications,and requirements:
Office of the Risk Management Officer ausa, (,61�6 Date: 2/3/2016
_YFDCF�)ffCT800498---------- .......
Financial Services
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control
Act: DocuSigned by:
Office of the Chief Financial Officer Date: 2/3/2016
______E 1-Ae
LeLyal Services
qtAj�ord by:
This agreement is approved as to legal form and 'R,'
Office of the County Attorney Date: 2/3/2016
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Donna Lloyd upon completion Cd,
The following signature block is for hard copies only and is not required for Docusign contracts:
Office of the Clerk to the Board ------ Date:..