HomeMy WebLinkAboutR 2016-514-E DSS - OPT - MOU to provide medical transportation to eligible Medicaid clients DocuSign Envelope ID: D843B726-9091-416C-B6AC-7EA85FE2894E
ORANGE COUNTY---DEPARTMENT USE ONLY---HARI) COPY ONLY
Department
Party/Vendor Name: Orange Public Transportation Party/Vendor Contact Person: Peter Murphy Contact Phone:
919-245-2002 Party/Vendor Address: P.O. Box 8181 City Hjfls� State: NC Zip: 27278 Department: DSS
Amount: $12.75 per way Purpose: Provide medical transportation to cligible Medicaid clients Budget Code(s):
10400020-760021 Vendor#_ (N/A if new vendor) Vendor is a BOCC consultant? Yes F NoEl Contract
Type: (Check one)New [] Renewal F Amendment 7 Effective Date 07/01/16 Approved by Board YesE]
NoF_j Agenda Date:
This agreement is approved as to technical form ird by:
Department Director's Signature st6w Date: 8/31/2016
Information Technologies
(Applicable only to hardwaralsQfiware 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 Manaizemen
This agreement is approved for sufficiency of insu awbWaQs,specifications,and requirements:
gusa, (hVVtff6
Office of Risk Management 77JIFE)GF-911680() Date�/24/2016
498
Financial Services
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control
Act: DocuSigned by:
8/31/2016
Office of the Chief Financial Officer Date:
Legal Services
This agreement is approved as to legal form and su ed by:
Office of the County Attorney Date: 9/1/2016
Clerk to the Board
Received for record retention:
Office of the Clerk to the Board Date:
DocuSigned by,
Revised
0637994B755E477