HomeMy WebLinkAboutR 2019-423 DSS - Chatham Transit nonemergency medical transportation DocuSign Envelope ID: FB28FAE1-FFC6-4AE8-BB72-9CC28168D54E Contract468-1019
Chatham Transit Network
ORANGE COUNTY—DEPARTMENT USE ONLY
Party/Vendor Name: Chatham Transit Network Party/Vendor Contact Person: Anna Tester-man Contact Phone: 919-542-5136
Party/Vendor Address: P.O. Box 1032 City Pittsboro State: NC Zip:27312 Department: Social Services Amount:N/A-State nays
directly Purpose:non-emergency medical transportation Budget Code(s):NIA-State pays directly Vendor#53945 (N/A ifnew vendor)
Vendor is a BOCC consultant? Yes❑No® Contract Type:(Check one)New❑ Renewal® Amendment ❑ Effective Date July 1,
2019 Approved by Board Yes❑No❑ Agenda Date:
This agreement is approved as to technical form and content and I as Department Director affirmatively state work on this project has not
been initiated prior to execution of the agreement:
DocuSigned by:
N (b&_ 7/8/2019
Department Director's Signature DAE1E198A83B455 Date:
Agreements for emergency services or repair are not subject to the above affirmation. If services related to this agreement have
already begun or been completed please briefly describe the nature of the emergency condition that was addressed:
Information Technologies
(Applicable only to hardwarelsoftware 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 Mana emeat
This agreement is approved for sufficienc Docusigned by: ' rds,specifications,and requirements:
a�sa �,bb 7/2/2019
Office of the Risk Management Office 7FDCF9176900498. Date:
Financial Services
This instrument has been pre-audited i DocuSigned by: the Local Government Budget and Fiscal Control Act:
� � 7/8/2019
Office of the Chief Financial Officer r4E51s,aCc,4os. Date:
Le
Yai Services
This agreement is approved as t Docu Sig ned by: 11cy:
7/9/2019
Office of the County Attorney 4035CB8304CA4A0 — bate:
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Sherri Ingersoll upon completion: singersollia@orangecountync.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 (06/19) Page 4 of 4