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HomeMy WebLinkAboutR 2018-479 DSS - Chatham Transit Network non-emergency Medicaid servicesDocuSign Envelope ID: EECFF652- EBBA- 43BD -91 B3- 20B28775BFD8 Contract #68-1016 Chatham Transit Network ORANGE COUNTY—DEPARTMENT USE ONLY Department PartyNendor Name: Chatham Transit Network Party/Vendor Contact Person: Anna Testerman Contact Phone: (919) 542 -5136 Party/Vendor Address: PO Box 1032 City Pittsboro State: NC Zip: 27312 Department: Social Services Amount: N/A -State pays directly_. Purpose: Non - Emergency Medicaid Transportation Budget Code(s): N/A -State pqys directly. Vendor #: 53945 (N /A if new vendor) Vendor is a BDCC consultant? Yes ❑ Nog Contract Type: (Check one) New ❑ Renewal Z Amendment ❑ Effective Date July I, 2417 Approved by Board Yes❑ No® Agenda Date: This agreement is approved as to tet Do cu Signed by: ,e " 6t& Llent: Eam � Department Director's Signature Date: 8/22/2018 DAEi E19SA83B455... - - -- Information Technologies (Applicable only to hardwarelsofhmare 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 Manay_cnicnt This agreement is approved for sufficienc- - oocusiened ay: -` °�' °ids, specifications, and requirements: QUS& (,b b 8/22/2018 Office of the Risk Management Office Date: 7F6GF917E800498. -. Financial Services This instrument has been pre- audited ' ©ocusigned ay' the Local Government Budget and Fiscal Control Act: z 8/23/2018 Office of the Chief Financial Officer 7DaE5 81ACGia09. -. Bate: __ -- This agreement is approved as t DocuSigned by: Office of the County Attorney 4035CB8304CA4A9... Legal Services ncy: Clerk to the Board Date: 8/24/2018 — Received for record retention: All Docusign contracts must be copied to Donna Lloyd upon completion @ Doi loyd a;oranecountyne,ga� The following signature block is for bard 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