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NORTH CAROLINA OFFICE OF EMERGENCY MEDICAL SERVICES <br />EMS SYSTEM PROPOSAL <br />DATE: (revised) March 30, 2004 <br />COUNTY NAME: Orange <br />COUNTY MANAGER NAME: John Link, Jr. <br />ADDRESS: <br />CITY: Hillsborough <br />P.O. Box 8181 <br />STATE: NC 9 DIGIT ZIP: 2 7 2 7 8- 8 1 8 1 <br />TELEPHONE: (919) 732-8181 <br />FAX NUMBER: (919) 644-3004 <br />FISCAL OFFICER (Authorized to complete budget and fund draw downs): <br />Ken Chavious, Finance Director <br />ADDRESS: P.O. Box 8181 <br />CITY: Hillsborough STATE: NC 9 DIGIT ZIP: 2 7 2 7 8- 8 1 8 1 <br />TELEPHONE: (919) 732-8181 <br />FAX NUMBER: (919) 644-3324 <br />Indicate if funds are to be paid by (check only one): <br />^ Paper Check <br />O Electronically transferred <br />Complete Vendor Electronic Payment Form and FAX or Return to: <br />Office of the State Controller - at address or number on form. <br />FEDERAL TAX IDENTIFICATION #: 56-6000327 <br />EMS SYSTEM NAME: Orange County EMS <br />PROJECT COORDINATOR: Kent McKenzie <br />TITLE: Emergency Management Deputy Director <br />ADDRESS: P.O. Box 8181 <br />CITY: Hillsborough STATE: NC ZII': 2 7 2 7 8- 8 1 8 1 <br />TELEPHONE: (919) 968-2050 <br />FAX NUMBER: (919) 968-4066 <br />EMAIL: kmckenzie(c~co.orange.nc.us <br /> <br />