HomeMy WebLinkAboutR 2019-432 DSS - OPT Medicaid transportation MOU DocuSign Envelope ID:43101116-0328-4364-BE8C-46E75760A1 F2
ORANGE COUNTY---DEPARTMENT USE ONLY
Department
PartylVendor Name: Orange County Public Transit Party/Vendor Contact Person: Theo Letman Contact Phone:
(919)245-2007 Party/Vendor Address: PO Box 8181 City Hillsborough State: NC Zip: 27278 Department: Social
Services Amount: NIA-State pays directly. Purpose: Non-Emergency Medicaid Transportation Budget Code(s):
NIA-State pays directly. Vendor #:N/A (NIA if new vendor) Vendor is a BOCC consultant? Yes ❑ NoM
Contract Type: (Check one) New ❑ Renewal M Amendment ❑ Effective Date July 1, 2019 Approved by
Board Yes[]No® Agenda Date:
This agreement is approved as to to rDocuSigned by: tent:
W6
5 7/9/2019
8A83B455
Department Director's Signature N V l Date:
DAE1E19
Information Technologies
(Applicable only to hardware/software 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_Management
This agreement is approved ft DocuSigned by: ante standards,specifications,and requirements:
Em sa. LQVIA. 6 6/26/2019
Office of Risk Management7FDCF9176900498. Date:
Financial Services
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control
Act: DocuSigned by:
4 � 7/9/2019
Office of the Chief Financial Officer 7D4S1ACC1409. Date:
Legal Services
This agreement is approved as t+ DocuSigned by: rcy:
�l,h�J �,mv._ 7/9/2019
Office of the County Attorney - _ Date.
4035CB8304CA4A9
Clerk to the Board
Received for record retention:
Office of the Clerk to the Board Date:
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