HomeMy WebLinkAboutAging - Certified Statement for Renewal Application for Elderly and Disabled Medicaid Transportation Assistance Program State of North Carolina, County of_Orange —�
Appendix C
Certified Statement
Pursuant to G.S. 13644.27, the North. Carolina Elderly and Disabled Transportation
Assistance Program, and pursuant to the Medicaid Transportation Assistance Program,
this is to certify that the undersigned is the duly elected, qualified and acting chairperson of the
Board of County Commissioners of the County of Orange North Carolina,
and that the following statements are true and correct:
1. That the funds received pursuant to GS.136-44.27 will be used to provide additional transportation services
for the elderly and disabled, exceeding the quantity of trips provided prior to the receipt of these funds.
2. That the funds received pursuant to G.S.136-44.27 will not be used to supplant existing Federal,State or local
funds designated to provide elderly and disabled transportation services in the county.
3. That the funds received pursuant to G.S.136-44.27 will be used in a mariner consistent with the local
Transportation Development Plan approved by the NC Department of T,ansportadon and the Board of
Commissioners.
4. It is understood that all semiannual allocations to the County pursuant to GS. 136-44.27 subsequent
to the first allocation will be made following the receipt of the progress report for the preceding sic months by the
North Carolina Department of Transportation, Public Transportation and Rail Division.
S. That zny interest earned on these funds rill be expended in accordance with G.S. 136-44.27.
6. That the funds received pursuant to Section 22,0 of House Bill 83 will be used to provide additional transportation
services for Medicaid eligible pregnant women and children (ages 0-19),and will be used to satisfy the maintenance
of effort requirement which means the county will increase transportation services above the level in fiscal year 1969-0-0.
7. That the funds received pursuant to Section 220 of House Bill 83 will no;supplant existing Federal,State,or local
funds designated to provide transportation services for Medicaid eligible pregnant women and children in the county.
S. That the funds received pursuant to Section 220 of House Bill 83 will be used in a manner consistent with the local
Transportation Development Plan approved by the NC Deparment of Transportation and the Board of Commissioners.
9. That the funds received pursuant to Section 220 of House Bill 83,6U not be used tow2rd the purchase of capital equipment.
WITNESS my hand and official seal, th1S eighth day of August 19 94
Attest:
t
Ccmfynng O I- Board of County C issionen
Chairperson
State of North Carolina county`, z$edAdministrator
County 01,274 �.
SubsriLed and sworn to me this day of-6qa�5'k 192W.
(SEAL)
Notary Public
My Commission expires
Address
'Note that the signatures on this statement should be those of four(4)separate individuals.