HomeMy WebLinkAboutR 2018-435 DSS - SHI-ORANGE LLC nonemergency medicaid transportation servicesDocuSign Envelope ID: AA1647C8 -B778- 4021- 9E83- EDC4C913A37C
Contract #68 -1014
SHl- Orange„ LLC dba The Stratford
ORANGE COUNTY— DEPARTMENT USE ONLY
Department
Party/Vendor Name: SHI- (}range, LLC dba The Stratford Party/Vendor Contact Person: Cameron Cook Contact Phone: (828) 270 -0656
Party/Vendor Address: 400 2 °d Avenue NW City Hickory State: NC Zip: 28601 Department: Social Services Amount: NIA -State nays
directly. Purpose: Non - Emergency Medicaid Transportation Budget Code(s): N/A -State pays directly. Vendor #: N/A (N /A ifnew vendor)
Vendor is a BOCC consultant? Yes ❑ NoN Contract Type: (Check one) New.E Renewal ❑ Amendment El Effective Date July_l
2018 Approved by Board Yes❑ No® Agenda Date:
This agreement is approved as to te1 oacusigned by:
Nam w6t&
Department Director's Signature
DAE1E196R83B455...
tent:
Information Technologies
Date:
8/14/2018
(Applicable only to hardwarelsojtware 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
Risk Management
Date:
This agreement is approved for sufficienc roocu5 eyed by: `- s -Pds, specifications, and requirements:
aUS& cbvw h 8/13/2018
Office of the Risk Management Officer Date:
7FDCF917E800498...
This instrument has been pre - audited ' Docusigned ay:
Office of the Chief Financial Officer
304E5181ACC1409...
Financial Services
the Local Government Budget and Fiscal Control Act:
Legal Services
Date: 8/20/2018
This agreement is approved as t - OocuSigned by: ncy_
Office of the +Count Attorney Date: 8/20/2018
4035CB8304CA4A9...
Clerk to the hoard
Received for record retention:
All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd@aorangecountync.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:
Contract - General (07/10) Page 5 of 5